Provider Demographics
NPI:1366770984
Name:ROBERT D BLEZA MD, LLC
Entity type:Organization
Organization Name:ROBERT D BLEZA MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:BLEZA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-663-8110
Mailing Address - Street 1:PO BOX 728
Mailing Address - Street 2:
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-0728
Mailing Address - Country:US
Mailing Address - Phone:219-663-8110
Mailing Address - Fax:219-663-8115
Practice Address - Street 1:115 E 113TH AVE
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-9706
Practice Address - Country:US
Practice Address - Phone:219-663-8110
Practice Address - Fax:219-663-8115
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-19
Last Update Date:2011-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty