Organization
LLOYD J BLAKEMAN III DOSC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LLOYD J BLAKEMAN III D.O. (PRESIDENT)
(708) 597-0032
Entity
Organization
Contact information
Practice address
7110 W 127TH ST, STE 250, PALOS HEIGHTS, IL 60463-1571
(708) 448-2077
(708) 671-8892
Mailing address
7110 W 127TH ST, PALOS HEIGHTS, IL 60463-1571
(708) 448-2077
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036-090891
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IL5796
GROUP PTAN
IL
01
—
IL5796001
INDIVIDUAL PTAN
IL
Enumeration date
03/05/2008
Last updated
03/08/2016
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