Healthcare Provider Details

I. General information

NPI: 1841220167
Provider Name (Legal Business Name): JACOB JAN HENDRIK BLEESING M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3333 BURNET AVE ML 7015
CINCINNATI OH
45229-3039
US

IV. Provider business mailing address

3333 BURNET AVE ML 5021
CINCINNATI OH
45229-3039
US

V. Phone/Fax

Practice location:
  • Phone: 513-636-4266
  • Fax: 513-636-3549
Mailing address:
  • Phone: 513-636-4225
  • Fax: 513-636-2511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35.084866
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code2080I0007X
TaxonomyPediatric Clinical & Laboratory Immunology Physician
License Number35.084866
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number35.084866
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: