Provider Demographics
NPI:1417288994
Name:DAVID A. BLEZA MD LLC
Entity Type:Organization
Organization Name:DAVID A. BLEZA MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-779-9721
Mailing Address - Street 1:PO BOX 1554
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46308-1554
Mailing Address - Country:US
Mailing Address - Phone:219-779-9721
Mailing Address - Fax:219-779-9726
Practice Address - Street 1:9150 E 109TH AVE STE 2D
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-7687
Practice Address - Country:US
Practice Address - Phone:219-779-9721
Practice Address - Fax:219-779-9726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-22
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty