Bloom, Kenneth Evan
Bloom, Kenneth Evan is an individual health care provider with primary practice located at 137 Professional Park Dr Suite C, Mooresville NC 28117-6540. He recently has 2 registered licenses in different health care specialties including Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery, Podiatric Medicine & Surgery Service Providers / Podiatrist. Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery is his primary health care specialty. Bloom, Kenneth Evan can be contacted via phone (704) 662-8336.Contact Information
Primary practice address
137 Professional Park Dr Suite C
Mooresville NC 28117-6540
Phone: (704) 662-8336
Fax: (704) 662-8525
Website:
Health care specialties
Specialty | Code | License # | State |
---|---|---|---|
Podiatric Medicine & Surgery Service Providers / Foot & Ankle Surgery | 213ES0103X | 414 | North Carolina |
Podiatric Medicine & Surgery Service Providers / Podiatrist | 213E00000X | 414 | North Carolina |
Profile Details
NPI number | 1811983372 |
---|---|
LBN Legal business name | Bloom, Kenneth Evan |
Credentials | Doctor of Podiatric Medicine (DPM) |
Entity | Individual |
Sole proprietor 1 | No |
Enumeration date | Sep 21st, 2005 |
Last updated | Aug 7th, 2023 - about last year |
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.
Identifiers
State | Type | Number | Issuer |
---|---|---|---|
All States | NPI | 1811983372 | NPPES |
North Carolina | MEDICAID | 790800H |
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