Provider Demographics
NPI:1932456126
Name:MICHAEL K. BLOCK, DPM, LLC
Entity Type:Organization
Organization Name:MICHAEL K. BLOCK, DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KEVIN
Authorized Official - Last Name:BLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:410-569-0445
Mailing Address - Street 1:3401 BOX HILL CORPORATE CENTER DRIVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ABINGDON
Mailing Address - State:MD
Mailing Address - Zip Code:21009-1201
Mailing Address - Country:US
Mailing Address - Phone:410-569-0445
Mailing Address - Fax:410-569-0446
Practice Address - Street 1:3401 BOX HILL CORPORATE CENTER DRIVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ABINGDON
Practice Address - State:MD
Practice Address - Zip Code:21009-1201
Practice Address - Country:US
Practice Address - Phone:410-569-0445
Practice Address - Fax:410-569-0446
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-07
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD01244213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1932456126Medicare NSC