Individual
NIMROD BLANK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
22720 MICHIGAN AVE STE 200, DEARBORN, MI 48124-2021
(313) 791-3000
(313) 791-2800
Mailing address
22720 MICHIGAN AVE STE 200, DEARBORN, MI 48124-2021
(313) 791-3000
(313) 791-2800
Taxonomy
Speciality
Code
Description
License number
State
207RC0000X
Cardiovascular Disease Physician
Primary
4301108677
MI
207RI0011X
Interventional Cardiology Physician
4301108677
FM
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
09/08/2015
Last updated
07/15/2024
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