Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 24MA08103100 | NJ |
N | 111NI0900X | Internist | 24MA08103100 | NJ |
N | 207RC0200X | Critical Care Medicine | 4301093855 | MI |
Y | 207RP1001X | Pulmonary Disease | 4301093855 | MI |
N | 207RS0012X | Sleep Medicine | 4301093855 | MI |
NPI | 1053490177 |
---|---|
Provider Name | John Blamoun |
First Address | Midland, MI 48640 |
Second Address | Midland, MI 48640 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 02/11/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I69634 | (02) | NJ |