MEDICARE: DR. HELEN SCOBLIC 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	207RH0002X	Hospice and Palliative Medicine (Internal Medicine) Physician	HS029829	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11-0-32-41921	OTHER	MI	BLUE CROSS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578771770
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. HELEN SCOBLIC M.D.

Provider Business Mailing Address
First Line	:	9214 LAKESHORE RD
Second Line	:
City	:	PORT AUSTIN
State	:	MI
Zip	:	48467-9234
Country	:	US
Telephone Number	:	989-738-7365
Fax Number	:	989-738-7365

Provider Business Practice Location Address
First Line	:	1426 STRAITS DR
Second Line	:
City	:	BAY CITY
State	:	MI
Zip	:	48706-8705
Country	:	US
Telephone Number	:	989-667-3440
Fax Number	:	989-667-3437

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

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	07/08/2007

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