Provider Demographics
NPI:1376523597
Name:LEVINE-BLASE, BARBARA (DO)
Entity Type:Individual
Prefix:
First Name:BARBARA
Middle Name:
Last Name:LEVINE-BLASE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:97 MONROE ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48226-2855
Mailing Address - Country:US
Mailing Address - Phone:313-965-3365
Mailing Address - Fax:313-965-3622
Practice Address - Street 1:2001 S MERRIMAN RD
Practice Address - Street 2:SUITE 100
Practice Address - City:WESTLAND
Practice Address - State:MI
Practice Address - Zip Code:48186-5539
Practice Address - Country:US
Practice Address - Phone:734-727-1000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101008931207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
E38493Medicare UPIN