Blomberg, Mary C

Blomberg, Mary C is an individual health care provider with primary practice located at 3850 Park Nicollet Blvd , St Louis Park MN 55416-2527. She recently has only one registered license in Allopathic & Osteopathic Physicians / Pediatrics, which is considered as her primary health care specialty. Blomberg, Mary C can be contacted via phone (952) 993-3298.

Contact Information

Primary practice address
3850 Park Nicollet Blvd St Louis Park MN 55416-2527
Phone: (952) 993-3298
Fax:
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Pediatrics 208000000X 41144 Minnesota

Profile Details

NPI number 1205813557
LBN Legal business name Blomberg, Mary C
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Dec 28th, 2005
Last updated Jun 27th, 2012 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205813557 NPPES
Minnesota MEDICAID 753224500

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