Blazek, Mary Carol
Blazek, Mary Carol is an individual health care provider with primary practice located at 4260 Plymouth Rd , Ann Arbor MI 48109-2700. She recently has 3 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Psychiatry, Allopathic & Osteopathic Physicians / Geriatric Psychiatry. Allopathic & Osteopathic Physicians / Psychiatry is her primary health care specialty. Blazek, Mary Carol can be contacted via phone (734) 936-4400.Contact Information
Primary practice address
4260 Plymouth Rd
Ann Arbor MI 48109-2700
Phone: (734) 936-4400
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Other Service Providers / Specialist | 174400000X | 4301078784 | Michigan |
| Allopathic & Osteopathic Physicians / Psychiatry | 2084P0800X | 4301078784 | Michigan |
| Allopathic & Osteopathic Physicians / Geriatric Psychiatry | 2084P0805X | 4301078784 | Michigan |
Profile Details
| NPI number | 1831240118 |
|---|---|
| LBN Legal business name | Blazek, Mary Carol |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Jan 15th, 2007 |
| Last updated | Sep 1st, 2010 - about 15 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1831240118 | NPPES |
| Michigan | MEDICAID | 104334765 | |
| Michigan | Other | 260H161260 |
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