Basic Information
Provider Information
NPI: 1730358854
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BLOCK
FirstName: WILLIAM
MiddleName: ALEXANDER
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: PO BOX 1239
Address2:  
City: TROY
State: MI
PostalCode: 480991239
CountryCode: US
TelephoneNumber: 2488246600
FaxNumber: 2483241477
Practice Location
Address1: 500 KIRTS BLVD
Address2:  
City: TROY
State: MI
PostalCode: 480844134
CountryCode: US
TelephoneNumber: 2488246600
FaxNumber: 2483241477
Other Information
ProviderEnumerationDate: 02/22/2008
LastUpdateDate: 07/24/2012
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207ZP0105XL1250464MIY Allopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine

No ID Information.


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