Healthcare Provider Details

I. General information

NPI: 1235392275
Provider Name (Legal Business Name): KATHLEEN DEGROFT BLAKE MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/09/2008
Last Update Date: 02/07/2025
Certification Date: 02/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7420 GOODING BLVD STE 100
DELAWARE OH
43015-7086
US

IV. Provider business mailing address

7750 DILEY RD STE A
CANAL WINCHESTER OH
43110-7758
US

V. Phone/Fax

Practice location:
  • Phone: 740-657-8000
  • Fax: 740-657-8100
Mailing address:
  • Phone: 614-837-7337
  • Fax: 614-837-7335

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number35088684
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: