Basic Information
| Provider Information | |||||||||
| NPI: | 1114213204 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLIXT | ||||||||
| FirstName: | JOHN | ||||||||
| MiddleName: | NIKLAS | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1447 N HARRISON ST | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486024727 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9895834220 | ||||||||
| FaxNumber: | 9895834287 | ||||||||
| Practice Location | |||||||||
| Address1: | 535 S BURDICK ST STE 160 | ||||||||
| Address2: | |||||||||
| City: | KALAMAZOO | ||||||||
| State: | MI | ||||||||
| PostalCode: | 490076113 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2693885864 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/27/2011 | ||||||||
| LastUpdateDate: | 08/20/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/20/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | 4301098800 | MI | N | Allopathic & Osteopathic Physicians | Internal Medicine | 207RP1001X | 4301098800 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease |
No ID Information.