Provider Demographics
NPI:1205243813
Name:ORTHOPEDIC SOLUTIONS OF NORTHERN MICHIGAN
Entity type:Organization
Organization Name:ORTHOPEDIC SOLUTIONS OF NORTHERN MICHIGAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:P
Authorized Official - Last Name:BLOCKSOM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:989-820-7339
Mailing Address - Street 1:295 MAPLE ST
Mailing Address - Street 2:STE 201
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48763-9352
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:295 MAPLE ST
Practice Address - Street 2:STE 201
Practice Address - City:TAWAS CITY
Practice Address - State:MI
Practice Address - Zip Code:48763-9352
Practice Address - Country:US
Practice Address - Phone:989-820-7339
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-15
Last Update Date:2014-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101013730207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Single Specialty