Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | MD057245L | PA |
N | 2080P0208X | Pediatric Infectious Diseases | MD057245L | PA |
NPI | 1295757706 |
---|---|
Provider Name | Michael D Blum |
First Address | Philadelphia, PA 19103-1443 |
Second Address | Philadelphia, PA 19104 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
8104301 | (05) | NJ |
D78025 | (02) |