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General NPI Number Information
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NPI Number | 1962554865
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Entity Type | Organization
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Legal Business Name | EDWARD A. BLANZY DO
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Dates
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Enumeration Date | 01/18/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 3231 WEST RD TRENTON SURGICAL BUILDING
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City | TRENTON
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State | MI
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Zip | 48183-2399
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Country | US
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Telephone | 734-775-4972
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Fax | 734-676-2032
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Provider Business Mailing Address
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Address Line | 351 S MILITARY ST
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City | DEARBORN
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State | MI
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Zip | 48124-1061
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Country | US
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Telephone | 313-278-5189
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Fax | 313-520-1898
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Authorized Official
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Title or Position | OWNER
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Name | EDWARD A. BLANZY
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Credential | DO
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Telephone | 734-775-4972
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208800000X
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Taxonomy Name | Urology Physician
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License Number |
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License Number State |
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