Provider Demographics
NPI:1093532202
Name:BOCK, PAUL
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:BOCK
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 1:3083 OSPREY DR
Mailing Address - Street 2:
Mailing Address - City:INTERLOCHEN
Mailing Address - State:MI
Mailing Address - Zip Code:49643-9383
Mailing Address - Country:US
Mailing Address - Phone:231-620-8721
Mailing Address - Fax:
Practice Address - Street 1:4230 COPPER RIDGE DR BLDG E
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49684-7256
Practice Address - Country:US
Practice Address - Phone:231-935-6716
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-20
Last Update Date:2024-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist