Provider Demographics
NPI:1649229816
Name:BLUM, MICHAEL R (MD)
Entity Type:Individual
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First Name:MICHAEL
Middle Name:R
Last Name:BLUM
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Gender:M
Credentials:MD
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Mailing Address - Street 1:4551 GLENCOE AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-6385
Mailing Address - Country:US
Mailing Address - Phone:310-301-2030
Mailing Address - Fax:310-306-5247
Practice Address - Street 1:15248 11TH ST
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3704
Practice Address - Country:US
Practice Address - Phone:760-245-8691
Practice Address - Fax:760-843-6020
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-08
Last Update Date:2024-04-05
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Provider Licenses
StateLicense IDTaxonomies
NV19575207P00000X
CAA61247207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine