Healthcare Provider Details

I. General information

NPI: 1689024606
Provider Name (Legal Business Name): NATALIE BLUM D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2016
Last Update Date: 07/25/2022
Certification Date: 07/25/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22101 MOROSS RD
DETROIT MI
48236-2148
US

IV. Provider business mailing address

31500 TELEGRAPH RD STE 100
BINGHAM FARMS MI
48025-4368
US

V. Phone/Fax

Practice location:
  • Phone: 313-343-4000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101024630
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5101022612
License Number StateMI
# 3
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number5315077006
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: