Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301085217 | MI |
Y | 2080P0210X | Pediatric Nephrologist | 4301085217 | MI |
NPI | 1144344771 |
---|---|
Provider Name | Dr. Neal Benjamin Blatt |
First Address | Southfield, MI 48033-3849 |
Second Address | Royal Oak, MI 48073-6770 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/03/2007 |
Last Update Date | 23/10/2020 |