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General NPI Number Information
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NPI Number | 1699872705
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Entity Type | Individual
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Provider Name | DAVID ARNOLD BLEZA MD
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Gender | Male
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Dates
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Enumeration Date | 09/20/2006
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Last Update Date | 05/22/2023
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Provider Practice Location Address
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Address Line | 9150 E 109TH AVE
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City | CROWN POINT
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State | IN
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Zip | 46307-7687
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Country | US
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Telephone | 219-779-9721
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Fax | 219-779-9726
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Provider Business Mailing Address
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Address Line | PO BOX 1554
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City | CROWN POINT
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State | IN
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Zip | 46308-1554
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Country | US
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Telephone | 219-736-6850
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Fax | 219-736-6855
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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 | 174400000X
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Taxonomy Name | Specialist
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License Number | 01052161A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | 01052161A
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License Number State | IN
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