Individual
MARCUS BLASS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
551 LINN ST, ALLEGAN, MI 49010-1595
(269) 686-5850
(269) 686-5897
Mailing address
551 LINN ST, ALLEGAN, MI 49010-1595
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
Primary
036710
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0200302138
BCBS MI PROVIDER #
MI
01
—
17-30505
PHP PROVIDER #
MI
01
—
1833840
UNITED HEALTHCARE
MI
01
—
21926
HEALTH PLAN OF MI
MI
01
—
2309
COMMUNITY CHOICE MI
MI
05
—
2632169
—
MI
01
—
MB036710
STATE LICENSE #
MI
01
—
P52808
BLUE CARE NETWORK PROV #
MI
Enumeration date
11/07/2005
Last updated
11/16/2007
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