Provider Demographics
NPI:1952392490
Name:BLUME, WILLIAM A (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:BLUME
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4501 N 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47710-3529
Mailing Address - Country:US
Mailing Address - Phone:812-422-7212
Mailing Address - Fax:812-422-7326
Practice Address - Street 1:4501 N 4TH AVE
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-3529
Practice Address - Country:US
Practice Address - Phone:812-422-7212
Practice Address - Fax:812-422-7326
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2022-02-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN01030705207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100247160AMedicaid
IN100247160AMedicaid
IN4213030001Medicare NSC
IN847500Medicare ID - Type Unspecified