Provider Demographics
NPI:1396005898
Name:BLOCK, KARA MICHELE (MD)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:MICHELE
Last Name:BLOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:155 CRYSTAL RUN RD
Mailing Address - Street 2:
Mailing Address - City:MIDDLETOWN
Mailing Address - State:NY
Mailing Address - Zip Code:10941-4028
Mailing Address - Country:US
Mailing Address - Phone:845-703-6999
Mailing Address - Fax:845-703-6297
Practice Address - Street 1:51 S BRIAN MICKELSEN PKWY
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326
Practice Address - Country:US
Practice Address - Phone:928-639-8132
Practice Address - Fax:866-274-8919
Is Sole Proprietor?:No
Enumeration Date:2012-05-18
Last Update Date:2018-06-01
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NY279376208000000X
AZ56125208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYA400125048Medicare PIN