Healthcare Provider Details

I. General information

NPI: 1245414135
Provider Name (Legal Business Name): JAMES FRANKLIN BLOOMFIELD III
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/27/2007
Last Update Date: 08/23/2022
Certification Date: 08/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1016 E CORK ST
KALAMAZOO MI
49001-4823
US

IV. Provider business mailing address

801 JOE MANN BLVD STE P-6
MIDLAND MI
48642-8900
US

V. Phone/Fax

Practice location:
  • Phone: 269-349-2247
  • Fax: 269-349-0529
Mailing address:
  • Phone: 989-791-2455
  • Fax: 989-791-1392

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1744P3200X
TaxonomyProsthetics Case Management
License Number335E00000X
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: