Basic Information
| Provider Information | |||||||||
| NPI: | 1841425261 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLOCK | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | GEORGE | ||||||||
| NamePrefix: | MR. | ||||||||
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| Credential: | M.S, , PH.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 21350 HIGHWAY 7 | ||||||||
| Address2: | |||||||||
| City: | EXCELSIOR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553317200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524701100 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 21350 HIGHWAY 7 | ||||||||
| Address2: | |||||||||
| City: | EXCELSIOR | ||||||||
| State: | MN | ||||||||
| PostalCode: | 553317200 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9524701100 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/29/2009 | ||||||||
| LastUpdateDate: | 10/27/2009 | ||||||||
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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 | 231H00000X | 5923 | MN | Y | Speech, Language and Hearing Service Providers | Audiologist |
No ID Information.