Individual
DR. MARIE MANTINI BLAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.P.M
Contact information
Practice address
7000 EUCLID AVE, SUITE 101, CLEVELAND, OH 44103-4014
(216) 231-5612
(216) 721-5534
Mailing address
17428 DEER RIDGE CIR, STRONGSVILLE, OH 44136-7258
(440) 887-9761
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
36.003426
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2787140
—
OH
01
—
CH5179
RR MEDICARE GROUP
OH
01
—
CI 5538
RR MEDICARE GROUP BFAC
OH
01
—
P00435157
RR MEDICARE CFAC
OH
Enumeration date
06/22/2007
Last updated
01/23/2014
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