Individual
BLAINE DENNIS
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Contact information
Practice address
44201 DEQUINDRE RD, EC, TROY, MI 48085-1117
(248) 964-5111
Mailing address
3601 W 13 MILE RD, 400-FSC/PCS, ROYAL OAK, MI 48073-6712
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
4301051100
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2684970
—
MI
Enumeration date
03/22/2006
Last updated
07/08/2007
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