Individual
ANNESSA R BLACKMUN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DPM
Contact information
Practice address
4350 N BROADWAY ST, FLOOR 2, CHICAGO, IL 60613-1781
(773) 770-0140
(773) 770-0141
Mailing address
PO BOX 23359, FLOOR 2, SAINT LOUIS, MO 63156-3359
(314) 932-1570
(314) 932-1571
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
016.005464
IL
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
2010035799
MO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1538321047
—
MO
01
—
P01781390
RAILROAD MEDICARE
MO
01
—
P01796928
RAILROAD MEDICARE
IL
Enumeration date
06/26/2008
Last updated
03/29/2017
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