Healthcare Provider Details

I. General information

NPI: 1285540377
Provider Name (Legal Business Name): MESSAN BLABUH MLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/20/2026
Last Update Date: 08/20/2026
Certification Date: 08/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3600 30TH ST
DES MOINES IA
50310-5753
US

IV. Provider business mailing address

3600 30TH ST
DES MOINES IA
50310-5753
US

V. Phone/Fax

Practice location:
  • Phone: 515-699-5829
  • Fax:
Mailing address:
  • Phone: 515-699-5829
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246QM0706X
TaxonomyMedical Technologist
License Number25291148
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: