Individual
SCOTT ANTHONY BLACKBURN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
11275 ALLEN RD, SOUTHGATE, MI 48195-3380
(313) 383-7071
(313) 383-7194
Mailing address
11275 ALLEN RD, SOUTHGATE, MI 48195-3380
(313) 383-7071
(313) 383-7194
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
4704326782
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
4704326782
STATE LICENSE
MI
Enumeration date
05/25/2022
Last updated
11/19/2025
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