Provider Demographics
NPI:1922545714
Name:BLIZE MEDICAL INC
Entity Type:Organization
Organization Name:BLIZE MEDICAL INC
Other - Org Name:KERAE MEDICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:UKEJE
Authorized Official - Middle Name:
Authorized Official - Last Name:ELENDU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-679-5105
Mailing Address - Street 1:743 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1130
Mailing Address - Country:US
Mailing Address - Phone:510-679-5105
Mailing Address - Fax:510-338-9751
Practice Address - Street 1:743 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:CA
Practice Address - Zip Code:94706-1130
Practice Address - Country:US
Practice Address - Phone:510-679-5105
Practice Address - Fax:510-338-9751
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-31
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79913332BX2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BX2000XSuppliersDurable Medical Equipment & Medical SuppliesOxygen Equipment & Supplies