Provider Demographics
NPI:1750339214
Name:BLOHM, KRISTINA B (MD)
Entity type:Individual
Prefix:
First Name:KRISTINA
Middle Name:B
Last Name:BLOHM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:PO BOX 27973
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-0149
Mailing Address - Country:US
Mailing Address - Phone:480-513-1042
Mailing Address - Fax:480-513-1043
Practice Address - Street 1:7344 E. DEER VALLEY RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255
Practice Address - Country:US
Practice Address - Phone:480-513-1042
Practice Address - Fax:480-513-1043
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
AZ34077207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZI41674Medicare UPIN
AZZ105540Medicare PIN