Individual
EVAN BLAZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
402 W COLLEGE AVE UNIT 2622, ADA, OH 45810-6109
(317) 474-5402
Mailing address
617 S GILBERT ST, ADA, OH 45810-1311
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
08/28/2025
Last updated
08/28/2025
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