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1568725810 NPI number — KEVIN BLAS M.D.

NPI Number: 1568725810
Health Care Provider/Practitioner: KEVIN BLAS M.D.

Information about “1568725810” NPI (KEVIN BLAS M.D.) exists in 1568725810 in HTML format HTML  |  1568725810 in plain Text format TXT  |  1568725810 in PDF (Portable Document Format) PDF  |  1568725810 in an XML format XML  formats.

NPI Number : 1568725810 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1568725810",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "BLAS",
    "FirstName": "KEVIN",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "M.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "3601 W 13 MILE RD",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "ROYAL OAK",
    "MailingAddressStateName": "MI",
    "MailingAddressPostalCode": "48073-6712",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "248-551-0570",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "166 STONERIDGE DR",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "COLUMBIA",
    "PracticeLocationAddressStateName": "SC",
    "PracticeLocationAddressPostalCode": "29210-8239",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "803-461-3000",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "06/21/2012",
    "LastUpdateDate": "11/01/2018",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": {
        "TaxonomyCode": "2085R0001X",
        "TaxonomyName": "Radiation Oncology Physician",
        "LicenseNumber": "430110966",
        "LicenseNumberStateCode": "MI",
        "PrimaryTaxonomySwitch": "Y"
      }
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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