Individual
MARK A BLAZEK
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
670 MALL DR, PORTAGE, MI 49024-2878
(269) 327-1900
(269) 327-1564
Mailing address
670 MALL DR, PORTAGE, MI 49024-2878
(269) 327-1900
(269) 327-1564
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
MB041426
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1398615
—
MI
Enumeration date
01/25/2006
Last updated
07/08/2007
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