=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780577429
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BLOCK-WHEELER MEDICAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/02/2025
-----------------------------------------------------
Last Update Date | 06/02/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2001 UNION ST STE 480
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94123-4128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-320-7720
-----------------------------------------------------
Fax | 510-256-0148
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2001 UNION ST STE 480
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94123-4128
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 415-320-7720
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DR. NIKOLAS BLOCK-WHEELER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 415-320-7720
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207YS0123X
-----------------------------------------------------
Taxonomy Name | Facial Plastic Surgery Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------