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
Fax: (704) 662-8525
Website:

Health care specialties

SpecialtyCodeLicense #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.

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Identifiers

StateTypeNumberIssuer
All States NPI 1811983372 NPPES
North Carolina MEDICAID 790800H

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