Dr. Ruperto Divino Blanco Jr., MD
Family Medicine in Wyoming, MI. Individual provider (NPI-1).
NPI number1790736643
StatusActive
Last updated in NPPESFeb 13, 2020
Details
- NPI
- 1790736643
- Entity type
- Individual (NPI-1)
- Name
- Dr. Ruperto Divino Blanco Jr.
- Credential
- MD
- Sex
- Male
- Sole proprietor
- No
- Enumeration date
- May 15, 2006
- Certification date
- Feb 13, 2020
- Last updated
- Feb 13, 2020
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 207Q00000X | Family Medicine | 4301076807 | MI | Yes |
Practice location
5838 Metro Way SwWyoming, MI 49519-9619
Phone 616-249-5300 · Fax 616-249-5410
Mailing address
5838 Metro Way SwWyoming, MI 49519-9619
Phone 616-249-5300 · Fax 616-249-5410
Other practice locations
4038 Alpine Ave Nw
Comstock Park, MI 49321
Comstock Park, MI 49321
Phone 616-827-2020 · Fax 616-827-2052
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