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Individual
JAMES D BLACK
Active
Individual
JAMES D BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DPM
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
Primary
JB001105
MI
332B00000X
Durable Medical Equipment & Medical Supplies
JB001105
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0731430001
DME - SUPPLIES, EQUIPMENT
MI
05
—
1626185
—
MI
01
—
382583434
FEDERAL ID
—
01
—
485635035
BLUE CROSS BLUE SHIELD MICHIGAN
—
01
—
5635035
PTAN
MI
Enumeration date
09/20/2005
Last updated
05/24/2012
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