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General NPI Number Information
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NPI Number | 1427194927
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Entity Type | Organization
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Legal Business Name | MAIN STREET FAMILY MEDICINE P C
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Dates
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Enumeration Date | 01/30/2007
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Last Update Date | 11/12/2009
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Provider Practice Location Address
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Address Line | 422 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1224
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Country | US
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Telephone | 248-348-1131
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Fax | 248-348-1170
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Provider Business Mailing Address
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Address Line | 422 N CENTER ST
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City | NORTHVILLE
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State | MI
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Zip | 48167-1224
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Country | US
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Telephone | 248-348-1131
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Fax | 248-348-1170
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Authorized Official
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Title or Position | CEO
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Name | NATHAN J BLOCH
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Credential | DO
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Telephone | 248-348-1131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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