Jeffrey A Blink, MD

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

30107 Issued in WI

Practice address

2845 Greenbrier Rd Ste 230
Green Bay, WI 54311-6519

Phone

(920) 288-8250

Fax

(920) 288-8255

NPI assigned

Jun 28, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 4

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1151452800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1452470400000",
    "number": "1376570796",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "164 N BROADWAY",
            "address_2": "PO BOX 8900",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543032728",
            "telephone_number": "920-288-8250",
            "fax_number": "920-288-8255"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2845 GREENBRIER RD STE 230",
            "city": "GREEN BAY",
            "state": "WI",
            "postal_code": "543116519",
            "telephone_number": "920-288-8250",
            "fax_number": "920-288-8255"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLINK",
        "first_name": "JEFFREY",
        "middle_name": "A",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-06-28",
        "last_updated": "2016-01-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WI",
            "license": "30107",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104470257",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "104358337",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "31473700",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD",
            "identifier": "770001953",
            "state": "WI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heidi Blanks, LPC
• Jordan Blasier, SLP
• Allison Lynn Blatz, NNP-BC
• Bridget G Blean, MAC
• Stacey Bleick
• Jeffrey Paul Blise, CRNA
• Bryanna R Blochowiak, D-PT
• Brooke Block, D.C.
• Connie Bloedel, CERTIFIED DIETICIAN
• Ruth Kraszewski Bloesl, FNP-BC APNP

• Surgery Physician in Green Bay, WI
• Providers in Green Bay, WI by specialty
• Surgery Physician in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 11, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.