Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 5901001851 | MI |
NPI | 1477551893 |
---|---|
Provider Name | Alan J. Bloch |
First Address | Northville, MI 48167-1224 |
Second Address | Northville, MI 48167-1224 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2005 |
Last Update Date | 15/09/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4453819 | (05) | MI |
U73875 | (02) | MI |