Individual
DR. SCOTT ALAN BLICKENSDERFER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
6301 UNIVERSITY COMMONS, STE 350, SOUTH BEND, IN 46635-1571
(574) 234-4100
(574) 282-1739
Mailing address
6301 UNIVERSITY COMMONS, STE 230, SOUTH BEND, IN 46635-1571
(574) 251-2100
(574) 251-2151
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
02001398A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0000000234054
ANTHEM
—
05
—
100093110
—
IN
01
—
264180V
MEDICARE PTAN
IN
Enumeration date
06/16/2005
Last updated
03/06/2014
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