Provider Demographics
NPI:1619362084
Name:KANDAH, BLAKE (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:
Last Name:KANDAH
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 1:1400 S POTOMAC ST STE 150
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80012-4541
Mailing Address - Country:US
Mailing Address - Phone:720-307-7246
Mailing Address - Fax:720-502-5271
Practice Address - Street 1:1400 S POTOMAC ST STE 150
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80012-4541
Practice Address - Country:US
Practice Address - Phone:720-476-3421
Practice Address - Fax:720-502-5271
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-02
Last Update Date:2021-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD1924392081P2900X
CODR.00651762081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine