1972734317 NPI number — MARTIN I. SCHOCK, MD PC

Table of content: (NPI 1972734317)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972734317 NPI number — MARTIN I. SCHOCK, MD PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARTIN I. SCHOCK, MD PC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MARTIN I SCHOCK
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972734317
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6039 HICKORY TREE TRL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BLOOMFIELD HILLS
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48301-1341
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
586-276-8131
Provider Business Mailing Address Fax Number:
586-276-8101

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
31700 VAN DYKE AVE
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
WARREN
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48093-7949
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
586-276-8131
Provider Business Practice Location Address Fax Number:
586-276-8101
Provider Enumeration Date:
08/03/2009

Additional Information

Authorized Official

Authorized Official Last Name:
SCHOCK
Authorized Official First Name:
MARTIN
Authorized Official Middle Name:
IRVIN
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
586-276-8131

Provider Taxonomy Codes

  • Taxonomy code: 261QX0200X , with the licence number:  4301027896 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1405362 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com