MEDICARE: DR. MARIE MANTINI BLAZER D.P.M

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	36.003426	OH

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	CH5179	OTHER	OH	RR MEDICARE GROUP
2	P00435157	OTHER	OH	RR MEDICARE CFAC
3	CI 5538	OTHER	OH	RR MEDICARE GROUP BFAC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083810485
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MARIE MANTINI BLAZER D.P.M

Provider Business Mailing Address
First Line	:	17428 DEER RIDGE CIR
Second Line	:
City	:	STRONGSVILLE
State	:	OH
Zip	:	44136-7258
Country	:	US
Telephone Number	:	440-887-9761
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 EUCLID AVE
Second Line	:	SUITE 101
City	:	CLEVELAND
State	:	OH
Zip	:	44103-4014
Country	:	US
Telephone Number	:	216-231-5612
Fax Number	:	216-721-5534

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	01/23/2014

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Directions to “ DR. MARIE MANTINI BLAZER D.P.M” Practice Location

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