MEDICARE: DR. TED BLOCH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207ZP0102X	Anatomic Pathology & Clinical Pathology Physician	01031608A	IN

General Provider Information

NPI Number	:	1083690960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TED BLOCH MD

Provider Business Mailing Address
First Line	:	14275 MIDWAY RD
Second Line	:	SUITE 400
City	:	ADDISON
State	:	TX
Zip	:	75001-3614
Country	:	US
Telephone Number	:	317-275-8000
Fax Number	:	610-271-4245

Provider Business Practice Location Address
First Line	:	2560 N. SHADELAND AVENUE
Second Line	:	SUITE A
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46219-1706
Country	:	US
Telephone Number	:	317-275-8000
Fax Number	:	317-275-8124

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/21/2005
Last Update Date	:	09/20/2016

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