Healthcare Provider Details

I. General information

NPI: 1356546949
Provider Name (Legal Business Name): NATHAN A WLOCH PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2007
Last Update Date: 12/12/2025
Certification Date: 12/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

IV. Provider business mailing address

44201 DEQUINDRE RD
TROY MI
48085-1117
US

V. Phone/Fax

Practice location:
  • Phone: 248-964-8433
  • Fax: 248-423-2576
Mailing address:
  • Phone: 248-964-8433
  • Fax: 248-423-2576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601005025
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: