Individual
BLAKE R NESTOK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
2139 AUBURN AVE, CINCINNATI, OH 45219-2906
(513) 585-7600
Mailing address
PO BOX 631104, CINCINNATI, OH 45263-1104
(800) 365-3744
(419) 866-5453
Taxonomy
Speciality
Code
Description
License number
State
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
35063456
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000015570
ANTHEM
OH
05
—
0886402
—
OH
05
—
200002650B
—
IN
05
—
64930233
—
KY
Enumeration date
10/27/2005
Last updated
06/03/2014
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