Provider Demographics
NPI:1417514621
Name:BLASEIO, JULIAN
Entity Type:Individual
Prefix:
First Name:JULIAN
Middle Name:
Last Name:BLASEIO
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 1:505 MAINSTREAM DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37228-1208
Mailing Address - Country:US
Mailing Address - Phone:629-895-0080
Mailing Address - Fax:629-895-5389
Practice Address - Street 1:505 MAINSTREAM DR
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37228-1208
Practice Address - Country:US
Practice Address - Phone:629-895-0080
Practice Address - Fax:629-895-5389
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-22
Last Update Date:2022-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN64456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine