DR. NICHOLAS WILLIAM BLANK (NPI# 1275914244) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1275914244 |
| Entity Type | Individual |
| Full Name | DR. NICHOLAS WILLIAM BLANK |
| Credential | M.D. |
| Practice Address |
2585 W Houghton Lake Dr Prudenville MI 48651-9624 |
| Mailing Address |
4081 Cascade Rd Se Ste 600 Grand Rapids MI 49546-2170 |
| Practice Telephone | 9893662900 |
| Mailing Telephone | 6162670800 |
| Mailing Fax Number | 8886904412 |
| Enumeration Date | 2015-06-15 |
| Last Update Date | 2020-10-12 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 4301107544 | MI | Allopathic & Osteopathic Physicians |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1250 E Michigan Ave, Grayling, MI 497387074 | 9893480550 | |
| 1100 E Michigan Ave, Grayling, MI 497381312 | 9893485461 | |
| 234 Lake St, Roscommon, MI 486539203 | 9892751200 | |
| 4081 Cascade Rd Se Ste 600, Grand Rapids, MI 495462170 | 6162670800 | 8886904412 |
| 2585 W Houghton Lake Dr, Prudenville, MI 486519624 | 9893662900 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1326434408 | Nicholas James Blank | Specialist/Technologist | 4841 69th Pl, Unit A, San Diego, CA 92115-3016 | 2015-04-15 |
| Street Address |
2585 W HOUGHTON LAKE DR |
| City | PRUDENVILLE |
| State | MI |
| Zip Code | 48651-9624 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023074960 | Cynthia K Rubert | Orthopaedic Surgery | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2006-04-20 |
| 1790209161 | Tammy Marie Milbocker | Nurse Practitioner | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2017-07-27 |
| 1952779555 | Devinn L Jeffers | Physician Assistant | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-09-13 |
| 1952787129 | Munson Healthcare Grayling | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2015-08-10 |
| 1144626052 | Munson Healthcare Grayling | Clinic/Center | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2014-11-05 |
| 1184977811 | Mercy Physician Network | Clinic/Center | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2012-10-18 |
| 1942561964 | Amanda Catherine Scott | Nurse Practitioner | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2012-06-06 |
| 1487974184 | James Gee | Internal Medicine | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2010-06-03 |
| 1346481553 | Mercy Hospital Grayling | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2009-03-18 |
| 1154571438 | Mhsn Primary Care Services | Psychologist | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2008-09-24 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710469036 | Stephenie Irish | Behavior Technician | Rise Center for Autism, 1840 West Houghton Lake Dr Unit 2, Prudenville, MI 48651 | 2018-09-04 |
| 1083965404 | Mercy Physician Network | Clinic/Center | 2585 W Houghton Lake Drive, Prudenville, MI 48651 | 2012-09-25 |
| 1609976968 | Kronner Pharmacy Inc | Pharmacy | 778 W Houghton Lake Dr, Prudenville, MI 48651 | 2006-09-25 |
| 1255352936 | Mclaren Primary Care | Family Medicine | 200 N. Grand Ave, Prudenville, MI 48651 | 2006-07-21 |
| 1053381871 | Marvin Earl Mcelroy | Internal Medicine | 1064 W West Branch Rd, Prudenville, MI 48651 | 2006-01-24 |
| 1598390080 | Rhiannon Burch | Behavior Technician | Rise Center for Autism, 1070 W. Houghton Lake Drive, Prudenville, MI 48651 | 2020-03-05 |
| 1629357090 | Mclaren Bay Region | Nurse Practitioner | 200 Grand Ave, Prudenville, MI 48651 | 2011-08-16 |
| 1427320894 | Patricia Henning Caswell | Counselor | 1401 Short Dr., Prudenville, MI 48651-0019 | 2012-02-01 |
| 1023015104 | Suzanne A Blanchard | Nurse Practitioner | 1401 Short Drive, Prudenville, MI 48651-0019 | 2005-07-05 |
| 1023640992 | Julie Ignatowski | Speech-Language Pathologist | 847 Springwood Dr, Prudenville, MI 48651-8405 | 2020-02-10 |
| Find all providers in zip 48651 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1255352936 | Mclaren Primary Care | Family Medicine | 200 N. Grand Ave, Prudenville, MI 48651 | 2006-07-21 |
| 1184711863 | Victor Luis Dominguez | Family Medicine | 2585 W Houghton Lake Dr, Prudenville, MI 48651-9624 | 2006-10-06 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1578163465 | Salta of Auburn Hills | Family Medicine | 2191 S South Blvd, Suite 101c, Pontiac, MI 48326-3481 | 2020-10-29 |
| 1396342606 | Kiwi Virtual Health Care Pllc | Family Medicine | 40618 Blythefield Ln, Canton, MI 48188-2251 | 2020-10-08 |
| 1447867619 | Bashar Yalldo Md Plc | Family Medicine | 14700 Farmington Rd Ste 105, Livonia, MI 48154-5434 | 2020-09-30 |
| 1245847342 | Nuha Bakkal | Family Medicine | 1422 Mill Pond Dr, Waterford, MI 48327-3088 | 2020-09-23 |
| 1710592050 | Chippewa County War Memorial Hospital Inc | Family Medicine | 391 E M 134, Cedarville, MI 49719-9451 | 2020-09-14 |
| 1184238966 | Med Clubs | Family Medicine | 2575 Hummingbird Dr, Holt, MI 48842-9430 | 2020-08-31 |
| 1457961054 | Danna Zevy | Family Medicine | 107 S Washington Ave Apt 401, Saginaw, MI 48607-1258 | 2020-08-07 |
| 1194342808 | Zachary Hillman Do Pllc | Family Medicine | 1794 N Lapeer Rd Ste A, Lapeer, MI 48446-7664 | 2020-06-29 |
| 1336765445 | Spectrum Health United | Family Medicine | 7188 Avenue B, Vestaburg, MI 48891-9502 | 2020-06-24 |
| 1477179711 | Spectrum Health United | Family Medicine | 1324 N County Line Rd, Blanchard, MI 49310-9303 | 2020-06-23 |
| Find all providers with the same taxonomy | ||||
| City | PRUDENVILLE |
| Zip Code | 48651 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.