| Doctor Name: | MR. CALEB ANTHONY YOUNGBLOOD |
| NPI Number: | 1235366014 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | MMS, PA-C |
| License Number: | 5601006038 |
| Business Practice Address: | 1964 W 11 Mile Rd Berkley, MI - 480723046 |
| Business Phone Number: | 2485449300 |
| Business Fax Number: | |
| Mailing Address: | 1964 W 11 Mile Rd, BERKLEY |
| State: | MI |
| Postal Code: | 480723046 |
| Phone Number: | 2485449300 |
| Fax Number: | |
| NPI Enumeration Date: | 06/18/2009 |
| NPI Last Update Date: | 02/24/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363AM0700X |
| License Number: | 5601006038 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Physician Assistant |
| Taxonomy Specialization: | Medical |
| Taxonomy Definition: | |