Provider Demographics
NPI:1568044139
Name:DR BLAKE MOVITZ PLLC
Entity type:Organization
Organization Name:DR BLAKE MOVITZ PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:RYAN
Authorized Official - Last Name:MOVITZ
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:248-821-1304
Mailing Address - Street 1:43422 W OAKS DR STE 301
Mailing Address - Street 2:
Mailing Address - City:NOVI
Mailing Address - State:MI
Mailing Address - Zip Code:48377-3300
Mailing Address - Country:US
Mailing Address - Phone:313-889-3456
Mailing Address - Fax:313-429-1021
Practice Address - Street 1:22401 FOSTER WINTER DR
Practice Address - Street 2:MEDICAL CLINIC
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3724
Practice Address - Country:US
Practice Address - Phone:313-889-3456
Practice Address - Fax:313-429-1021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-23
Last Update Date:2024-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty