| Doctor Name: | KEVIN BLAU |
| NPI Number: | 1356724025 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | D.O |
| License Number: | 5101022071 |
| Business Practice Address: | 20415 Northville Place Drive North Apt 2307 Northville, MI - 48167 |
| Business Phone Number: | 4144267631 |
| Business Fax Number: | |
| Mailing Address: | 20415 Northville Place Drive North, Apt 2307 NORTHVILLE |
| State: | MI |
| Postal Code: | 48167 |
| Phone Number: | 4144267631 |
| Fax Number: | |
| NPI Enumeration Date: | 06/30/2015 |
| NPI Last Update Date: | 06/30/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | 5101022071 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |