Provider Demographics
NPI:1952391252
Name:NESTOK, BLAKE R (MD)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:R
Last Name:NESTOK
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:PO BOX 631104
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-1104
Mailing Address - Country:US
Mailing Address - Phone:800-365-3744
Mailing Address - Fax:419-866-5453
Practice Address - Street 1:2139 AUBURN AVE
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-585-7600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35063456207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0886402Medicaid
KY64930233Medicaid
IN200002650BMedicaid
OH000000015570OtherANTHEM
OHNE0786074Medicare PIN
IN187820BMedicare PIN
OH000000015570OtherANTHEM
OH0786074Medicare PIN
IN200002650BMedicaid
KY0516609Medicare PIN
OHNE0786071Medicare PIN