Individual
JASON R BLAZINA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1000 N 92ND ST, MILWAUKEE, WI 53226-3533
(414) 479-9400
(414) 259-1663
Mailing address
6141 W MORGAN AVE, MILWAUKEE, WI 53220-1311
(414) 479-9400
(414) 259-1663
Taxonomy
Speciality
Code
Description
License number
State
172A00000X
Driver
Primary
B425-4366-9058-05
WI
Other
Enumeration date
05/23/2007
Last updated
04/17/2012
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