Provider Demographics
NPI:1972600666
Name:BLOOMER, MICHELE MARJORIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:MARJORIE
Last Name:BLOOMER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF CALIFORNIA SAN FRANCISCO
Mailing Address - Street 2:10 KORET WAY, RM K220, BOX 0730
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0001
Mailing Address - Country:US
Mailing Address - Phone:415-476-3705
Mailing Address - Fax:415-476-3511
Practice Address - Street 1:461 SCENIC AVE
Practice Address - Street 2:
Practice Address - City:PIEDMONT
Practice Address - State:CA
Practice Address - Zip Code:94611-3420
Practice Address - Country:US
Practice Address - Phone:415-476-3705
Practice Address - Fax:415-476-3511
Is Sole Proprietor?:No
Enumeration Date:2006-09-17
Last Update Date:2010-01-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA72716207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAH70343Medicare UPIN