Healthcare Provider Details

I. General information

NPI: 1386632313
Provider Name (Legal Business Name): JOHN BLEBEA MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2005
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

912 S WASHINGTON AVE
SAGINAW MI
48601-2564
US

IV. Provider business mailing address

1000 HOUGHTON AVE.
SAGINAW MI
48602
US

V. Phone/Fax

Practice location:
  • Phone: 918-744-3523
  • Fax: 918-744-3463
Mailing address:
  • Phone: 989-583-6800
  • Fax: 989-583-6955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number28809
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number4301111451
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number28809
License Number StateOK
# 4
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number4301111451
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: