Provider Demographics
NPI:1538208764
Name:BLOCK, KEITH I (MD)
Entity type:Individual
Prefix:MR
First Name:KEITH
Middle Name:I
Last Name:BLOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 4543
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-4543
Mailing Address - Country:US
Mailing Address - Phone:800-834-8787
Mailing Address - Fax:847-807-4916
Practice Address - Street 1:5230 OLD ORCHARD RD
Practice Address - Street 2:
Practice Address - City:SKOKIE
Practice Address - State:IL
Practice Address - Zip Code:60077-1034
Practice Address - Country:US
Practice Address - Phone:847-492-3040
Practice Address - Fax:847-492-3045
Is Sole Proprietor?:No
Enumeration Date:2007-02-05
Last Update Date:2016-06-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL036061051207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC45313Medicare UPIN
ILK19763Medicare ID - Type Unspecified
ILC45313Medicare UPIN