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:
Map and Directions

Health care specialties

SpecialtyCodeLicense #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 9 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 1770586448 NPPES
California MEDICAID 00G250100

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