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General NPI Number Information
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NPI Number | 1578748315
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Entity Type | Organization
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Legal Business Name | BLAKE M SLATER D O P C
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Dates
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Enumeration Date | 12/28/2007
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Last Update Date | 11/23/2009
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Provider Practice Location Address
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Address Line | 391 EAST HIGHWAY M-134 POB 630
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City | CEDARVILLE
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State | MI
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Zip | 49719-0630
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Country | US
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Telephone | 906-484-2295
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Fax | 906-484-2614
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Provider Business Mailing Address
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Address Line | PO BOX 630
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City | CEDARVILLE
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State | MI
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Zip | 49719-0630
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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 | D O
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Name | DR. BLAKE M SLATER
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Credential |
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Telephone | 906-484-2295
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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 | 007998
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License Number State | MI
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