Healthcare Provider Details

I. General information

NPI: 1417752221
Provider Name (Legal Business Name): GENERATIONS FAMILY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/17/2025
Last Update Date: 04/30/2025
Certification Date: 04/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12660 TEN MILE RD STE C
SOUTH LYON MI
48178-9141
US

IV. Provider business mailing address

37712 EMERALD FOREST DR
FARMINGTON HILLS MI
48331-5952
US

V. Phone/Fax

Practice location:
  • Phone: 248-270-8081
  • Fax:
Mailing address:
  • Phone: 248-661-9944
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. NATHAN JOSEPH BLOCH
Title or Position: PRESIDENT
Credential: DO
Phone: 248-270-8081