Provider Demographics
NPI:1134548696
Name:MOVITZ, BLAKE RYAN (MD)
Entity type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:RYAN
Last Name:MOVITZ
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:43422 W OAKS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3300
Mailing Address - Country:US
Mailing Address - Phone:313-889-3456
Mailing Address - Fax:313-429-1021
Practice Address - Street 1:22401 FOSTER WINTER DR
Practice Address - Street 2:
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3724
Practice Address - Country:US
Practice Address - Phone:313-889-3456
Practice Address - Fax:313-429-1021
Is Sole Proprietor?:No
Enumeration Date:2014-04-14
Last Update Date:2024-07-30
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4301501607208600000X
MN65467208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery