Basic Information
| Provider Information | |||||||||
| NPI: | 1114580909 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOK | ||||||||
| FirstName: | NEIL | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | 2920 TAUBMAN CENTER | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095331 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1500 E. MEDICAL CENTER DRIVE | ||||||||
| Address2: | TAUBMAN CENTER 2ND FLOOR, RECEPTION F | ||||||||
| City: | ANN ARBOR | ||||||||
| State: | MI | ||||||||
| PostalCode: | 481095332 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7349365738 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/17/2019 | ||||||||
| LastUpdateDate: | 04/17/2019 | ||||||||
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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 | 390200000X | 4351044197 | MI | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.