Healthcare Provider Details

I. General information

NPI: 1477457752
Provider Name (Legal Business Name): OLGA BLUM MLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2026
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

231 LITTLE LAKE DR
ANN ARBOR MI
48103-6247
US

IV. Provider business mailing address

27610 CHATHAM PL
FARMINGTON HILLS MI
48334-3606
US

V. Phone/Fax

Practice location:
  • Phone: 734-223-3520
  • Fax:
Mailing address:
  • Phone: 313-590-1446
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number6361008379
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: