Basic Information
| Provider Information | |||||||||
| NPI: | 1174586747 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCKER | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | EDWARD | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043845416 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Practice Location | |||||||||
| Address1: | 1900 RANDOLPH RD STE 216 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282071106 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7043165330 | ||||||||
| FaxNumber: | 7043845992 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/06/2006 | ||||||||
| LastUpdateDate: | 08/11/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 174400000X | 9600215 | NC | N | Other Service Providers | Specialist | 207RI0200X | 9600215 | NC | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease |
ID Information
| ID | Type | State | Issuer | Description | 200157944 | 01 | NC | CIGNA | OTHER | C8899 | 01 | NC | MEDCOST | OTHER | 346879 | 01 | NC | GREAT WEST | OTHER | 200157944 | 01 | NC | HUMANA GOLD CHOICE | OTHER | 010238323 | 05 | VA | MEDICAID | 200157944 | 01 | NC | AMERICAN REPUBLIC | OTHER | 2117717 | 01 | NC | MAMSI | OTHER | 6579469 | 01 | NC | CIGNA | OTHER | 17461 | 01 | NC | PARTNER'S MEDICARE | OTHER | 199003 | 01 | NC | WELLPATH | OTHER | 200157944 | 01 | NC | COMPCARE | OTHER | 5711536 | 01 | NC | AETNA | OTHER | 891037P | 05 | NC | MEDICAID | 200157944 | 01 | NC | SOUTH CARE PPO | OTHER | 200157944 | 01 | NC | HEALTHCARE SAVINGS | OTHER | 9022381 | 01 | NC | UNITED HEALTHCARE | OTHER | 1037P | 01 | NC | BLUE CROSS/ BLUE SHIELD | OTHER | 301145600 | 01 | NC | OWCP | OTHER |