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General NPI Number Information
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NPI Number | 1205243813
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Entity Type | Organization
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Legal Business Name | ORTHOPEDIC SOLUTIONS OF NORTHERN MICHIGAN
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Dates
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Enumeration Date | 07/15/2014
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Last Update Date | 08/26/2014
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Provider Practice Location Address
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Address Line | 295 MAPLE ST STE 201
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City | TAWAS CITY
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State | MI
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Zip | 48763-9352
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Country | US
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Telephone | 989-820-7339
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Fax |
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Provider Business Mailing Address
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Address Line | 295 MAPLE ST STE 201
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City | TAWAS CITY
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State | MI
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Zip | 48763-9352
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JOHN P BLOCKSOM
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Credential | D.O.
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Telephone | 989-820-7339
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101013730
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License Number State | MI
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