Blum, Mitchell Edward
Blum, Mitchell Edward is an sole proprietor health care provider with primary practice located at 2160 W. Grantline Rd Suite 250, Tracy CA 95377. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Otolaryngology, Allopathic & Osteopathic Physicians / Facial Plastic Surgery. Allopathic & Osteopathic Physicians / Otolaryngology is his primary health care specialty. Blum, Mitchell Edward can be contacted via phone (209) 834-0626.Contact Information
Primary practice address
2160 W. Grantline Rd Suite 250
Tracy CA 95377
Phone: (209) 834-0626
Fax: (209) 834-1814
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Otolaryngology | 207Y00000X | G25010 | California |
| Allopathic & Osteopathic Physicians / Facial Plastic Surgery | 207YS0123X | G25010 | California |
Profile Details
| NPI number | 1770586448 |
|---|---|
| LBN Legal business name | Blum, Mitchell Edward |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | May 24th, 2005 |
| Last updated | Apr 30th, 2015 - about 10 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.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1770586448 | NPPES |
| California | MEDICAID | 00G250100 |
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