Provider Demographics
NPI:1770621252
Name:BLACKER, CHARLA M (MD)
Entity type:Individual
Prefix:
First Name:CHARLA
Middle Name:M
Last Name:BLACKER
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1056 DEVONSHIRE RD
Mailing Address - Street 2:
Mailing Address - City:GROSSE POINTE PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48230-1417
Mailing Address - Country:US
Mailing Address - Phone:313-885-1052
Mailing Address - Fax:
Practice Address - Street 1:1500 W BIG BEAVER RD
Practice Address - Street 2:STE 105
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48084-3526
Practice Address - Country:US
Practice Address - Phone:248-637-4050
Practice Address - Fax:248-637-4025
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301048499207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive Endocrinology