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General NPI Number Information
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NPI Number | 1235392275
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Entity Type | Individual
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Provider Name | KATHLEEN DEGROFT BLAKE MD
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Gender | Female
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Dates
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Enumeration Date | 07/09/2008
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Last Update Date | 02/07/2025
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Provider Practice Location Address
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Address Line | 7420 GOODING BLVD STE 100
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City | DELAWARE
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State | OH
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Zip | 43015-7086
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Country | US
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Telephone | 740-657-8000
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Fax | 740-657-8100
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Provider Business Mailing Address
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Address Line | 7750 DILEY RD STE A
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City | CANAL WINCHESTER
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State | OH
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Zip | 43110-7758
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Country | US
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Telephone | 614-837-7337
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Fax | 614-837-7335
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 35088684
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License Number State | OH
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