Provider Demographics
NPI:1790891083
Name:STEVE BLICBLUM, M.D.,P.A.
Entity Type:Organization
Organization Name:STEVE BLICBLUM, M.D.,P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:BLICBLUM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:813-681-9507
Mailing Address - Street 1:PO BOX 852
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33509-0852
Mailing Address - Country:US
Mailing Address - Phone:813-681-9507
Mailing Address - Fax:813-681-5403
Practice Address - Street 1:431 LITHIA PINECREST RD
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-6138
Practice Address - Country:US
Practice Address - Phone:813-681-9507
Practice Address - Fax:813-681-5403
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1003841925OtherNPI
FL1447285440OtherNPI
FL1447285440OtherNPI
FL30506Medicare ID - Type Unspecified
FLD21471Medicare UPIN
FL05BDHNGMedicare ID - Type Unspecified
FL1003841925OtherNPI