Provider Demographics
NPI:1639392780
Name:ALAN J. BLOCH DPM, PLLC
Entity Type:Organization
Organization Name:ALAN J. BLOCH DPM, PLLC
Other - Org Name:NORTHVILLE PODIATRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:J
Authorized Official - Last Name:BLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:248-449-7156
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
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-10
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001851213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4858252720OtherBLUE CARE NETWORK
MI4453819Medicaid
MIU73875OtherHAP
MI4388464OtherCIGNA
MA4858252120OtherBLUE CROSS
MI136186OtherCARE CHOICES
MI7507277OtherAETNA
MIU73875OtherHAP
MI=========OtherUNITED HEALTHCARE
MA=========OtherPHCS
MI4453819Medicaid
MI4858252720OtherBLUE CARE NETWORK
MI7507277OtherAETNA
MI=========OtherGREATWEST
MI=========OtherDMC CARE
MI=========OtherBEECHSTREET
MI=========OtherTRICARE
MI7507277OtherAETNA
MIU73875Medicare UPIN