Provider Demographics
NPI:1033308853
Name:BLUME, MICHAEL M (LPN)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:M
Last Name:BLUME
Suffix:
Gender:M
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1001 HICKORY ST
Mailing Address - Street 2:
Mailing Address - City:MARATHON
Mailing Address - State:WI
Mailing Address - Zip Code:54448-9337
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1001 HICKORY ST
Practice Address - Street 2:
Practice Address - City:MARATHON
Practice Address - State:WI
Practice Address - Zip Code:54448-9337
Practice Address - Country:US
Practice Address - Phone:715-443-3767
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-10-17
Last Update Date:2007-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse