Individual
MS. MELISSA A BLANCO
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
929 W HIGGINS RD, SCHAUMBURG, IL 60195-3203
(847) 285-4200
(847) 885-0130
Mailing address
1 WESTBROOK CORPORATE CTR 240, WESTCHESTER, IL 60154-5745
(708) 236-2673
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085-002766
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P00641695
MEDICARE RAILROAD
IL
Enumeration date
11/02/2006
Last updated
12/10/2015
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