Individual
MARY CAROL BLAZEK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
4260 PLYMOUTH RD, ANN ARBOR, MI 48109-2700
(734) 936-4400
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
4301078784
MI
2084P0800X
Psychiatry Physician
Primary
4301078784
MI
2084P0805X
Geriatric Psychiatry Physician
4301078784
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
104334765
—
MI
01
—
260H161260
BCBS GRP
MI
Enumeration date
01/15/2007
Last updated
09/01/2010
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