Basic Information
| Provider Information | |||||||||
| NPI: | 1396005898 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCK | ||||||||
| FirstName: | KARA | ||||||||
| MiddleName: | MICHELE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 155 CRYSTAL RUN RD | ||||||||
| Address2: | |||||||||
| City: | MIDDLETOWN | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109414028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8457036999 | ||||||||
| FaxNumber: | 8457036297 | ||||||||
| Practice Location | |||||||||
| Address1: | 51 S BRIAN MICKELSEN PKWY | ||||||||
| Address2: | |||||||||
| City: | COTTONWOOD | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 86326 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9286398132 | ||||||||
| FaxNumber: | 8662748919 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/18/2012 | ||||||||
| LastUpdateDate: | 06/01/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208000000X | 279376 | NY | N | Allopathic & Osteopathic Physicians | Pediatrics | 208000000X | 56125 | AZ | Y | Allopathic & Osteopathic Physicians | Pediatrics |
No ID Information.