Provider Demographics
NPI:1700888211
Name:BLUMENREICH, PATRICIA ESTELA (MD)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:ESTELA
Last Name:BLUMENREICH
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:ESTELA
Other - Last Name:DULMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:540 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:WACONIA
Mailing Address - State:MN
Mailing Address - Zip Code:55387-1601
Mailing Address - Country:US
Mailing Address - Phone:952-442-4437
Mailing Address - Fax:952-442-3084
Practice Address - Street 1:540 E 1ST ST
Practice Address - Street 2:
Practice Address - City:WACONIA
Practice Address - State:MN
Practice Address - Zip Code:55387-1601
Practice Address - Country:US
Practice Address - Phone:952-442-4437
Practice Address - Fax:952-442-3084
Is Sole Proprietor?:No
Enumeration Date:2005-08-15
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN381132084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1524334OtherUBH MEDICA
MNHP30289OtherHEALTH PARTNERS
MN1015941OtherPREFERRED ONE
MN737018100Medicaid
MN121372OtherU CARE
MN82D10BLOtherBLUE CROSS BLUE SHIELD
MN82D10BLOtherBLUE CROSS BLUE SHIELD
MNHP30289OtherHEALTH PARTNERS