Provider Demographics
NPI:1659784338
Name:PUTMAN, BLAKE (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:PUTMAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 W CARO RD STE VI
Mailing Address - Street 2:
Mailing Address - City:CARO
Mailing Address - State:MI
Mailing Address - Zip Code:48723-8209
Mailing Address - Country:US
Mailing Address - Phone:989-673-6144
Mailing Address - Fax:989-672-1800
Practice Address - Street 1:1800 W CARO RD STE VI
Practice Address - Street 2:
Practice Address - City:CARO
Practice Address - State:MI
Practice Address - Zip Code:48723-8209
Practice Address - Country:US
Practice Address - Phone:989-673-6144
Practice Address - Fax:989-672-1800
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-10
Last Update Date:2023-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301105933207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine