Provider Demographics
NPI:1235384785
Name:MICHAEL R BLOCK M D INC
Entity Type:Organization
Organization Name:MICHAEL R BLOCK M D INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-459-4321
Mailing Address - Street 1:970 MONUMENT ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:PACIFIC PALISADES
Mailing Address - State:CA
Mailing Address - Zip Code:90272-3800
Mailing Address - Country:US
Mailing Address - Phone:310-459-4321
Mailing Address - Fax:310-459-5326
Practice Address - Street 1:970 MONUMENT ST
Practice Address - Street 2:SUITE 210
Practice Address - City:PACIFIC PALISADES
Practice Address - State:CA
Practice Address - Zip Code:90272-3800
Practice Address - Country:US
Practice Address - Phone:310-459-4321
Practice Address - Fax:310-459-5326
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2009-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
No207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty