Provider Demographics
NPI:1841425261
Name:BLOCK, MICHAEL GEORGE (MS, , PHD)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:GEORGE
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MS, , PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21350 HIGHWAY 7
Mailing Address - Street 2:
Mailing Address - City:EXCELSIOR
Mailing Address - State:MN
Mailing Address - Zip Code:55331-7200
Mailing Address - Country:US
Mailing Address - Phone:952-470-1100
Mailing Address - Fax:
Practice Address - Street 1:21350 HIGHWAY 7
Practice Address - Street 2:
Practice Address - City:EXCELSIOR
Practice Address - State:MN
Practice Address - Zip Code:55331-7200
Practice Address - Country:US
Practice Address - Phone:952-470-1100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-29
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN5923231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist