Provider Demographics
NPI:1700831690
Name:MYHRA-BLOOM, KARLA GAY (MD)
Entity Type:Individual
Prefix:
First Name:KARLA
Middle Name:GAY
Last Name:MYHRA-BLOOM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:709 17TH ST N
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-1631
Mailing Address - Country:US
Mailing Address - Phone:320-259-0120
Mailing Address - Fax:
Practice Address - Street 1:709 17TH ST N
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377
Practice Address - Country:US
Practice Address - Phone:320-259-0120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-23
Last Update Date:2018-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN350722085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1600536OtherMEDICA
MN1016709OtherPREFERRED ONE
WI300099552OtherRAILROAD MEDICARE WI
MN127385OtherUCARE
MN300124849OtherRAILROAD MEDICARE MN
MN56G37BLOtherBLUE CROSS
MN706860300Medicaid
MN96D61MYOtherBLUE CROSS
WI32423300Medicaid
MNHP33809OtherHEALTHPARTNERS
MN1421754OtherAMERICA'S PPO
MN253804OtherMIDLANDS CHOICE INC
MN9238143OtherDAKOTA CARE
WI300099552OtherRAILROAD MEDICARE WI
MN253804OtherMIDLANDS CHOICE INC
MN300002958Medicare PIN
MN300002589Medicare PIN
MN96D61MYOtherBLUE CROSS
MN56G37BLOtherBLUE CROSS