Individual
ROBERTA E BLANDON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
1875 DEMPSTER ST STE 665, PARK RIDGE, IL 60068
(847) 825-1590
(847) 825-1604
Mailing address
1875 DEMPSTER ST STE 665, PARK RIDGE, IL 60068-1168
(847) 825-1590
(847) 825-1604
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
2001015985
MO
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
Primary
036147113
IL
207VF0040X
Urogynecology and Reconstructive Pelvic Surgery (Obstetrics & Gynecology) Physician
2001015985
MO
207VG0400X
Gynecology Physician
036147113
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036147113
—
IL
05
—
2001015985
—
MO
05
—
L6224
—
TX
Enumeration date
01/05/2006
Last updated
08/09/2018
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