Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RH0003X | Hematology & Oncology | 4301027896 | MI |
NPI | 1063478428 |
---|---|
Provider Name | Dr. Martin Irvin Schock |
First Address | Warren, MI 48093-3474 |
Second Address | Warren, MI 48093-3474 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/04/2006 |
Last Update Date | 24/02/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1405362 | (05) | MI |
B47444 | (02) | MI |