Provider Demographics
NPI:1528493392
Name:PRICE, BLAINE (PA)
Entity type:Individual
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First Name:BLAINE
Middle Name:
Last Name:PRICE
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Gender:M
Credentials:PA
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Mailing Address - Street 1:555 W WACKERLY ST
Mailing Address - Street 2:SUITE 2600
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-4722
Mailing Address - Country:US
Mailing Address - Phone:989-835-8865
Mailing Address - Fax:989-492-7839
Practice Address - Street 1:555 W WACKERLY ST
Practice Address - Street 2:SUITE 2600
Practice Address - City:MIDLAND
Practice Address - State:MI
Practice Address - Zip Code:48640-4722
Practice Address - Country:US
Practice Address - Phone:989-835-8865
Practice Address - Fax:989-492-7839
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-11
Last Update Date:2013-09-11
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Provider Licenses
StateLicense IDTaxonomies
MI5601006775363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant