Healthcare Provider Details

I. General information

NPI: 1649229816
Provider Name (Legal Business Name): MICHAEL R. BLUM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

18133 VENTURA BLVD
TARZANA CA
91356-3612
US

IV. Provider business mailing address

4018 CAMINO PLANO
CALABASAS CA
91302-3017
US

V. Phone/Fax

Practice location:
  • Phone: 818-981-3818
  • Fax:
Mailing address:
  • Phone: 310-403-1711
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA61247
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number19575
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: