Basic Information
| Provider Information | |||||||||
| NPI: | 1235136599 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLESSED | ||||||||
| FirstName: | WILLIAM | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | BLESSED | ||||||||
| OtherFirstName: | WILLIAM | ||||||||
| OtherMiddleName: | BRIAN | ||||||||
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| OtherLastNameType: | 2 | ||||||||
| Mailing Information | |||||||||
| Address1: | 15990 W 9 MILE RD | ||||||||
| Address2: | |||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480754826 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488494226 | ||||||||
| FaxNumber: | 2488494240 | ||||||||
| Practice Location | |||||||||
| Address1: | 22255 GREENFIELD RD | ||||||||
| Address2: | STE 350 | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753712 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2488492710 | ||||||||
| FaxNumber: | 2488494844 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/01/2005 | ||||||||
| LastUpdateDate: | 05/09/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207VM0101X | 4301405802 | MI | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Maternal & Fetal Medicine |
ID Information
| ID | Type | State | Issuer | Description | 285429210 | 05 | MI | MEDICAID |