Organization
CLARKSTON LAKES FAMILY MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. JOHN A BLANCHARD MD (OWNER/PHYSICIAN)
(248) 922-3074
Entity
Organization
Contact information
Practice address
6483 CITATION DR, SUITE B, CLARKSTON, MI 48346-2994
(248) 922-3074
(248) 922-3081
Mailing address
6483 CITATION DR, SUITE B, CLARKSTON, MI 48346-2994
(248) 922-3074
(248) 922-3081
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
JB067853
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080F320090
BCN
MI
05
—
1457359267
—
MI
01
—
CK5028
RAILROAD MEDICARE GROUP
MI
Enumeration date
07/14/2005
Last updated
02/20/2012
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