| Blueze LLC | |
|
2412 E Washington St Suite 6 Bloomington IL 61704-4497 | |
| (309) 585-2116 | |
| (309) 585-2152 |
| Full Name | Blueze LLC |
|---|---|
| Speciality | Family Medicine |
| Location | 2412 E Washington St, Bloomington, Illinois |
| Authorized Official Name and Position | Joel Nilles (SOLE MBR) |
| Authorized Official Contact | 3095852116 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blueze LLC 2412 E Washington St Suite 6 Bloomington IL 61704-4497 Ph: (309) 585-2116 | Blueze LLC 2412 E Washington St Suite 6 Bloomington IL 61704-4497 Ph: (309) 585-2116 |
| NPI Number | 1306371299 |
|---|---|
| Provider Enumeration Date | 04/27/2017 |
| Last Update Date | 04/27/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1306371299 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 036099319 (Illinois) | Primary |
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