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General NPI Number Information
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NPI Number | 1275144586
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Entity Type | Organization
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Legal Business Name | LAWRENCE BLASE MD
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Dates
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Enumeration Date | 08/11/2020
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Last Update Date | 08/11/2020
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Provider Practice Location Address
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Address Line | 30335 W 13 MILE RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2262
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Country | US
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Telephone | 248-626-6500
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Fax |
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Provider Business Mailing Address
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Address Line | 30335 W 13 MILE RD STE 100
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City | FARMINGTON HILLS
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State | MI
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Zip | 48334-2262
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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 | OWNER
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Name | LAWRENCE BLASE
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Credential | MD
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Telephone | 248-626-6500
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VG0400X
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Taxonomy Name | Gynecology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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