Individual
BLAISE EBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
2799 W GRAND BLVD, DETROIT, MI 48202-2608
(800) 653-6568
(313) 876-1305
Mailing address
1 FORD PL STE 3A, DETROIT, MI 48202-3450
(313) 876-4806
(313) 876-1305
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601011612
MI
363AS0400X
Surgical Physician Assistant
—
—
Other
Enumeration date
07/16/2021
Last updated
03/17/2023
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