Provider Demographics
NPI:1770965725
Name:BLAZEK, CODY DOUGLAS (DPM)
Entity type:Individual
Prefix:
First Name:CODY
Middle Name:DOUGLAS
Last Name:BLAZEK
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 LOCUST ST
Mailing Address - Street 2:BUILDING B #9520
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15219-5114
Mailing Address - Country:US
Mailing Address - Phone:412-232-5515
Mailing Address - Fax:
Practice Address - Street 1:1400 LOCUST ST
Practice Address - Street 2:BUILDING B #9520
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15219-5114
Practice Address - Country:US
Practice Address - Phone:412-232-5515
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-26
Last Update Date:2015-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASC006654213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist