Provider Demographics
NPI:1174586747
Name:BLOCKER, MICHAEL EDWARD (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:EDWARD
Last Name:BLOCKER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:704-384-5416
Mailing Address - Fax:704-384-5992
Practice Address - Street 1:1900 RANDOLPH RD STE 216
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28207-1106
Practice Address - Country:US
Practice Address - Phone:704-316-5330
Practice Address - Fax:704-384-5992
Is Sole Proprietor?:No
Enumeration Date:2006-04-06
Last Update Date:2021-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC9600215174400000X, 207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC200157944OtherCIGNA
NCC8899OtherMEDCOST
NC346879OtherGREAT WEST
NC200157944OtherHUMANA GOLD CHOICE
VA010238323Medicaid
NC200157944OtherAMERICAN REPUBLIC
NC2117717OtherMAMSI
NC6579469OtherCIGNA
NC17461OtherPARTNER'S MEDICARE
NC199003OtherWELLPATH
NC200157944OtherCOMPCARE
NC5711536OtherAETNA
NC891037PMedicaid
NC200157944OtherSOUTH CARE PPO
NC200157944OtherHEALTHCARE SAVINGS
NC9022381OtherUNITED HEALTHCARE
NC1037POtherBLUE CROSS/ BLUE SHIELD
NC301145600OtherOWCP
NC17461OtherPARTNER'S MEDICARE
VA010238323Medicaid