Basic Information
| Provider Information | |||||||||
| NPI: | 1063478428 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SCHOCK | ||||||||
| FirstName: | MARTIN | ||||||||
| MiddleName: | IRVIN | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11885 E 12 MILE RD | ||||||||
| Address2: | SUITE 100A | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480933474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865761615 | ||||||||
| FaxNumber: | 5865761628 | ||||||||
| Practice Location | |||||||||
| Address1: | 11885 E 12 MILE RD | ||||||||
| Address2: | SUITE 100A | ||||||||
| City: | WARREN | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480933474 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5865761615 | ||||||||
| FaxNumber: | 5865761628 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/25/2006 | ||||||||
| LastUpdateDate: | 02/24/2016 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | 4301027896 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 1405362 | 05 | MI | MEDICAID |