Provider Demographics
NPI:1386634897
Name:BLUM, ROBERT M (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:M
Last Name:BLUM
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:31500 TELEGRAPH RD
Mailing Address - Street 2:STE 105
Mailing Address - City:BINGHAM FARMS
Mailing Address - State:MI
Mailing Address - Zip Code:48025-4367
Mailing Address - Country:US
Mailing Address - Phone:248-540-8700
Mailing Address - Fax:248-540-8701
Practice Address - Street 1:31500 TELEGRAPH RD
Practice Address - Street 2:STE 105
Practice Address - City:BINGHAM FARMS
Practice Address - State:MI
Practice Address - Zip Code:48025-4367
Practice Address - Country:US
Practice Address - Phone:248-540-8700
Practice Address - Fax:248-540-8701
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI5101010973208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1573028Medicaid
F46889Medicare UPIN
MI1573028Medicaid