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General NPI Number Information
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NPI Number | 1568825388
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Entity Type | Individual
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Provider Name | BLAKE SZELESTEY MD
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Gender | Male
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Dates
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Enumeration Date | 03/30/2016
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Last Update Date | 09/24/2021
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Provider Practice Location Address
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Address Line | 9000 N MAIN ST STE 320
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City | ENGLEWOOD
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State | OH
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Zip | 45415-1185
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Country | US
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Telephone | 937-496-2600
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Fax |
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Provider Business Mailing Address
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Address Line | 1222 S PATTERSON BLVD STE 400
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City | DAYTON
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State | OH
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Zip | 45402-2642
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Country | US
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Telephone | 937-496-2600
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Fax |
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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 | 207Y00000X
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Taxonomy Name | Otolaryngology Physician
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License Number | 35.143234
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License Number State | OH
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