Provider Demographics
NPI:1407523988
Name:BLAU, DANIEL ADAM
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:ADAM
Last Name:BLAU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6620 AINTREE PARK DR APT 202
Mailing Address - Street 2:
Mailing Address - City:MAYFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:44143-3565
Mailing Address - Country:US
Mailing Address - Phone:216-978-7304
Mailing Address - Fax:
Practice Address - Street 1:12395 MCCRACKEN RD
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44125-2967
Practice Address - Country:US
Practice Address - Phone:216-587-6727
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator