Provider Demographics
NPI:1568825388
Name:SZELESTEY, BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:SZELESTEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 S PATTERSON BLVD STE 400
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45402-2642
Mailing Address - Country:US
Mailing Address - Phone:937-496-2600
Mailing Address - Fax:
Practice Address - Street 1:9000 N MAIN ST STE 320
Practice Address - Street 2:
Practice Address - City:ENGLEWOOD
Practice Address - State:OH
Practice Address - Zip Code:45415-1185
Practice Address - Country:US
Practice Address - Phone:937-496-2600
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-30
Last Update Date:2021-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.143234207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty