Healthcare Provider Details

I. General information

NPI: 1750339214
Provider Name (Legal Business Name): KRISTINA B. BLOHM M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7344 E. DEER VALLEY RD. SUITE 100
SCOTTSDALE AZ
85255
US

IV. Provider business mailing address

PO BOX 27973
SCOTTSDALE AZ
85255-0149
US

V. Phone/Fax

Practice location:
  • Phone: 480-513-1042
  • Fax: 480-513-1043
Mailing address:
  • Phone: 480-513-1042
  • Fax: 480-513-1043

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number34077
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: