Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207K00000X | Allergist & Immunologist | 18696 | MN |
NPI | 1083729537 |
---|---|
Provider Name | Dr. Paul Mitchell Blum |
First Address | Edina, MN 55435-5655 |
Second Address | Edina, MN 55435-5655 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01668BL | BC/BS (01) | MN |
0204351 | MEDICA (01) | MN |
A93957 | (02) | MN |
FP9020802001 | PREFERRED ONE (01) | MN |