Provider Demographics
NPI:1962554865
Name:EDWARD A. BLANZY DO
Entity type:Organization
Organization Name:EDWARD A. BLANZY DO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:A
Authorized Official - Last Name:BLANZY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:734-775-4972
Mailing Address - Street 1:351 S MILITARY ST
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48124-1061
Mailing Address - Country:US
Mailing Address - Phone:313-278-5189
Mailing Address - Fax:313-520-1898
Practice Address - Street 1:3231 WEST RD
Practice Address - Street 2:TRENTON SURGICAL BUILDING
Practice Address - City:TRENTON
Practice Address - State:MI
Practice Address - Zip Code:48183-2399
Practice Address - Country:US
Practice Address - Phone:734-775-4972
Practice Address - Fax:734-676-2032
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0M27930Medicare ID - Type Unspecified