Individual
MR. JUSTIN DAVID BLYTHE JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1875 DEMPSTER ST STE 625, PARK RIDGE, IL 60068-1137
(847) 723-4088
(847) 627-8700
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
163WN0800X
Neuroscience Registered Nurse
Primary
041548967
IL
363L00000X
Nurse Practitioner
209-032573
IL
363LF0000X
Family Nurse Practitioner
209-032573
IL
Other
Enumeration date
10/21/2024
Last updated
10/21/2025
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