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General NPI Number Information
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NPI Number | 1770621252
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Entity Type | Individual
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Provider Name | CHARLA M BLACKER M.D.
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Gender | Female
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Dates
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Enumeration Date | 02/05/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 W BIG BEAVER RD STE 105
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City | TROY
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State | MI
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Zip | 48084-3526
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Country | US
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Telephone | 248-637-4050
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Fax | 248-637-4025
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Provider Business Mailing Address
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Address Line | 1056 DEVONSHIRE RD
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City | GROSSE POINTE PARK
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State | MI
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Zip | 48230-1417
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Country | US
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Telephone | 313-885-1052
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207VE0102X
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Taxonomy Name | Reproductive Endocrinology Physician
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License Number | 4301048499
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License Number State | MI
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