Provider Demographics
NPI:1063478428
Name:SCHOCK, MARTIN IRVIN (MD)
Entity Type:Individual
Prefix:DR
First Name:MARTIN
Middle Name:IRVIN
Last Name:SCHOCK
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:11885 E 12 MILE RD
Mailing Address - Street 2:SUITE 100A
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-3474
Mailing Address - Country:US
Mailing Address - Phone:586-576-1615
Mailing Address - Fax:586-576-1628
Practice Address - Street 1:11885 E 12 MILE RD
Practice Address - Street 2:SUITE 100A
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-3474
Practice Address - Country:US
Practice Address - Phone:586-576-1615
Practice Address - Fax:586-576-1628
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-02-24
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301027896207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1405362Medicaid
MI1405362Medicaid
MIB47444Medicare UPIN