Individual
DR. MICHAEL ANOTONIO BLALOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
835 S VAN BUREN ST, GREEN BAY, WI 54301-3575
(920) 433-0111
Mailing address
1162 BROOKWOOD DR APT 312, GREEN BAY, WI 54304-4146
(312) 217-7450
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
76147-20
WI
Other
Enumeration date
04/02/2019
Last updated
06/27/2023
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