Healthcare Provider Details

I. General information

NPI: 1144252842
Provider Name (Legal Business Name): R MICHAEL BLUMHOFF JR. MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/06/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9897 W MCDOWELL RD STE 100
TOLLESON AZ
85353
US

IV. Provider business mailing address

4424 E KIRKLAND RD
PHOENIX AZ
85050
US

V. Phone/Fax

Practice location:
  • Phone: 480-563-1058
  • Fax:
Mailing address:
  • Phone: 480-563-1058
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number29590
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: