Provider Demographics
NPI:1952462798
Name:BLUMHARDT, MICHAEL R (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:BLUMHARDT
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 1:2825 E BARNETT RD
Mailing Address - Street 2:MSS
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8332
Mailing Address - Country:US
Mailing Address - Phone:541-789-4281
Mailing Address - Fax:541-789-4803
Practice Address - Street 1:2825 E BARNETT RD
Practice Address - Street 2:MSS
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8332
Practice Address - Country:US
Practice Address - Phone:541-789-7000
Practice Address - Fax:541-789-4281
Is Sole Proprietor?:No
Enumeration Date:2006-12-13
Last Update Date:2023-04-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CO45596207RC0200X, 207RP1001X
TN38561207RC0200X, 207RP1001X
IDM-11294207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNP00156912OtherRAILROAD MEDICARE
TN4088388OtherBCBS TN
TN3893441Medicaid
TN3725122Medicaid
TN3893441Medicaid
TN3725122Medicare ID - Type Unspecified
TN3893441Medicare ID - Type Unspecified