MEDICARE: DR. MICHAEL EDWARD BLOCKER M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	9600215	NC
2	207RI0200X	Infectious Disease Physician	9600215	NC

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
9	17461	OTHER	NC	PARTNER'S MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	200157944	OTHER	NC	CIGNA
2	C8899	OTHER	NC	MEDCOST
3	346879	OTHER	NC	GREAT WEST
4	200157944	OTHER	NC	HUMANA GOLD CHOICE
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	200157944	OTHER	NC	AMERICAN REPUBLIC
7	2117717	OTHER	NC	MAMSI
8	6579469	OTHER	NC	CIGNA
10	199003	OTHER	NC	WELLPATH
11	200157944	OTHER	NC	COMPCARE
12	5711536	OTHER	NC	AETNA
13	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
14	200157944	OTHER	NC	SOUTH CARE PPO
15	200157944	OTHER	NC	HEALTHCARE SAVINGS
16	9022381	OTHER	NC	UNITED HEALTHCARE
17	1037P	OTHER	NC	BLUE CROSS/ BLUE SHIELD
18	301145600	OTHER	NC	OWCP

General Provider Information

NPI Number	:	1174586747
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL EDWARD BLOCKER M.D.

Provider Business Mailing Address
First Line	:	PO BOX 60447
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28260-0447
Country	:	US
Telephone Number	:	704-384-5416
Fax Number	:	704-384-5992

Provider Business Practice Location Address
First Line	:	1900 RANDOLPH RD STE 216
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28207-1106
Country	:	US
Telephone Number	:	704-316-5330
Fax Number	:	704-384-5992

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	08/11/2021

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Directions to “ DR. MICHAEL EDWARD BLOCKER M.D.” Practice Location

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