Provider Demographics
NPI:1235392275
Name:BLAKE, KATHLEEN DEGROFT (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:DEGROFT
Last Name:BLAKE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7750 DILEY RD STE A
Mailing Address - Street 2:
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-7758
Mailing Address - Country:US
Mailing Address - Phone:614-837-7337
Mailing Address - Fax:614-837-7335
Practice Address - Street 1:7420 GOODING BLVD STE 100
Practice Address - Street 2:
Practice Address - City:DELAWARE
Practice Address - State:OH
Practice Address - Zip Code:43015-7086
Practice Address - Country:US
Practice Address - Phone:740-657-8000
Practice Address - Fax:740-657-8100
Is Sole Proprietor?:No
Enumeration Date:2008-07-09
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35088684208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2890242Medicaid