Provider Demographics
NPI:1306834171
Name:BLOOM, MICHAEL L (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:L
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:4302 ALTON RD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33140-2891
Mailing Address - Country:US
Mailing Address - Phone:305-532-2999
Mailing Address - Fax:305-672-4803
Practice Address - Street 1:4302 ALTON RD
Practice Address - Street 2:SUITE 850
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33140-2891
Practice Address - Country:US
Practice Address - Phone:305-532-2999
Practice Address - Fax:305-672-4803
Is Sole Proprietor?:No
Enumeration Date:2005-10-06
Last Update Date:2008-02-21
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
FLME0055835207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLE61687Medicare UPIN
FL10666WMedicare PIN