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NPI Code Detail

MEDICARE: DR. MAUREEN MIKHO BLACKBURN DDS

MEDICARE: DR. MAUREEN MIKHO BLACKBURN DDS
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
1122300000XDentist2901022231MI

General Provider Information

NPI Number : 1902334006
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MAUREEN MIKHO BLACKBURN DDS
Provider Business Mailing Address
First Line : 117 W PATERSON ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-2557
Country : US
Telephone Number : 269-349-2641
Fax Number : 269-201-2855
Provider Business Practice Location Address
First Line : 117 W PATERSON ST
Second Line :
City : KALAMAZOO
State : MI
Zip : 49007-2581
Country : US
Telephone Number : 269-349-2641
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/01/2017
Last Update Date : 05/23/2024

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