Provider Demographics
NPI:1942280706
Name:BLOOM, NORMAN ARTHUR (MD)
Entity Type:Individual
Prefix:DR
First Name:NORMAN
Middle Name:ARTHUR
Last Name:BLOOM
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 1:21097 NE 27 CT SUITE 101
Mailing Address - Street 2:
Mailing Address - City:AVENTURA
Mailing Address - State:FL
Mailing Address - Zip Code:33180
Mailing Address - Country:US
Mailing Address - Phone:305-931-6663
Mailing Address - Fax:305-466-5777
Practice Address - Street 1:21097 NE 27 CT SUITE 101
Practice Address - Street 2:
Practice Address - City:AVENTURA
Practice Address - State:FL
Practice Address - Zip Code:33180
Practice Address - Country:US
Practice Address - Phone:305-931-6663
Practice Address - Fax:305-466-5777
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-18
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0014272208800000X
FL0014272208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL056153300Medicaid
D59460Medicare UPIN
91008BMedicare ID - Type Unspecified
FLD59460Medicare UPIN
FL056153300Medicaid