1639392780 NPI number — ALAN J. BLOCH DPM, PLLC

Table of content: (NPI 1639392780)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639392780 NPI number — ALAN J. BLOCH DPM, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ALAN J. BLOCH DPM, PLLC
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:
NORTHVILLE PODIATRY
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:
1639392780
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/15/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
422 N CENTER ST
Provider Second Line Business Mailing Address:
SUITE B
Provider Business Mailing Address City Name:
NORTHVILLE
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
48167-1224
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
248-449-7156
Provider Business Mailing Address Fax Number:
248-449-9666

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
422 N CENTER ST
Provider Second Line Business Practice Location Address:
SUITE B
Provider Business Practice Location Address City Name:
NORTHVILLE
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
48167-1224
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
248-449-7156
Provider Business Practice Location Address Fax Number:
248-449-9666
Provider Enumeration Date:
04/10/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BLOCH
Authorized Official First Name:
ALAN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
MEMBER
Authorized Official Telephone Number:
248-449-7156

Provider Taxonomy Codes

  • Taxonomy code: 213ES0131X , with the licence number:  5901001851 , 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: 4858252720 . This is a "BLUE CARE NETWORK" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4453819 , issued by the state of ( MI ) . This identifiers is of the category "MEDICAID".
  • Identifier: U73875 . This is a "HAP" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4388464 . This is a "CIGNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 4858252120 . This is a "BLUE CROSS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 136186 . This is a "CARE CHOICES" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".
  • Identifier: 7507277 . This is a "AETNA" identifier , issued by the state of ( MI ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com