Provider Demographics
NPI:1255345930
Name:BLOCH, NATHAN J (DO)
Entity type:Individual
Prefix:
First Name:NATHAN
Middle Name:J
Last Name:BLOCH
Suffix:
Gender:
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37712 EMERALD FOREST DR
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48331-5952
Mailing Address - Country:US
Mailing Address - Phone:248-767-2255
Mailing Address - Fax:
Practice Address - Street 1:12660 TEN MILE RD STE C
Practice Address - Street 2:
Practice Address - City:SOUTH LYON
Practice Address - State:MI
Practice Address - Zip Code:48178-9141
Practice Address - Country:US
Practice Address - Phone:248-270-8081
Practice Address - Fax:248-963-5675
Is Sole Proprietor?:No
Enumeration Date:2006-07-28
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101012982207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4118116Medicaid
MIOH24978OtherBLUE CROSS BLUE SHIELS OF
MI080153298OtherMEDICARE RAILROAD
MI080153298OtherMEDICARE RAILROAD
MIOH24978OtherBLUE CROSS BLUE SHIELS OF