Provider Demographics
NPI:1083420830
Name:BLOCK, BRANDON MILO
Entity type:Individual
Prefix:
First Name:BRANDON
Middle Name:MILO
Last Name:BLOCK
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12099 SIGILLARY WAY
Mailing Address - Street 2:
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-6329
Mailing Address - Country:US
Mailing Address - Phone:317-853-9236
Mailing Address - Fax:
Practice Address - Street 1:12099 SIGILLARY WAY
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-6329
Practice Address - Country:US
Practice Address - Phone:317-853-9236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-12-06
Last Update Date:2024-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program