Healthcare Provider Details

I. General information

NPI: 1285671776
Provider Name (Legal Business Name): CRAIG ALAN BLOCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CHILDRENS HOSPITAL MI CRITICAL CARE MED 3901 BEAUBIEN 4TH FLOOR - CARL'S BUILDING
DETROIT MI
48201
US

IV. Provider business mailing address

2799 W GRAND BLVD
DETROIT MI
48202-2608
US

V. Phone/Fax

Practice location:
  • Phone: 313-745-5629
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301056307
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: