Provider Demographics
NPI:1477551893
Name:BLOCH, ALAN J (DPM)
Entity Type:Individual
Prefix:
First Name:ALAN
Middle Name:J
Last Name:BLOCH
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:422 N CENTER ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48167-1224
Mailing Address - Country:US
Mailing Address - Phone:248-449-7156
Mailing Address - Fax:248-449-9666
Practice Address - Street 1:422 N CENTER ST
Practice Address - Street 2:SUITE B
Practice Address - City:NORTHVILLE
Practice Address - State:MI
Practice Address - Zip Code:48167-1224
Practice Address - Country:US
Practice Address - Phone:248-449-7156
Practice Address - Fax:248-449-9666
Is Sole Proprietor?:No
Enumeration Date:2005-07-09
Last Update Date:2008-09-15
Deactivation Date:2006-03-16
Deactivation Code:
Reactivation Date:2006-03-20
Provider Licenses
StateLicense IDTaxonomies
MI5901001851213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4453819Medicaid
MI5706130001Medicare NSC
MIU73875Medicare UPIN