Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 4301034122 | MI |
NPI | 1013017854 |
---|---|
Provider Name | John David Blaha |
First Address | Ann Arbor, MI 48108-1633 |
Second Address | Ann Arbor, MI 48105-9484 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/09/2006 |
Last Update Date | 19/07/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4463969 | (05) | MI |
A72702 | (02) | MI |