Basic Information
| Provider Information | |||||||||
| NPI: | 1568825388 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SZELESTEY | ||||||||
| FirstName: | BLAKE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1222 S PATTERSON BLVD STE 400 | ||||||||
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| City: | DAYTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454022642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962600 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9000 N MAIN ST STE 320 | ||||||||
| Address2: | |||||||||
| City: | ENGLEWOOD | ||||||||
| State: | OH | ||||||||
| PostalCode: | 454151185 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9374962600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2016 | ||||||||
| LastUpdateDate: | 09/24/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Y00000X | 35.143234 | OH | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Otolaryngology |
No ID Information.