Provider Demographics
NPI:1417998485
Name:BLUM, ADAM H (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:H
Last Name:BLUM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5910 LANDERBROOK DR
Mailing Address - Street 2:#250
Mailing Address - City:MAYFIELD HTS
Mailing Address - State:OH
Mailing Address - Zip Code:44124-6508
Mailing Address - Country:US
Mailing Address - Phone:440-684-5865
Mailing Address - Fax:440-449-1555
Practice Address - Street 1:11100 EUCLID AVE
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106-1736
Practice Address - Country:US
Practice Address - Phone:216-844-1700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350639422085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0352532Medicaid
OHG98719Medicare UPIN
OH0352532Medicaid