Healthcare Provider Details

I. General information

NPI: 1689697260
Provider Name (Legal Business Name): KEVIN M BLUEMEL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 1ST CENTER AVE
BRODHEAD WI
53520-1937
US

IV. Provider business mailing address

2310 1ST CENTER AVE
BRODHEAD WI
53520-1937
US

V. Phone/Fax

Practice location:
  • Phone: 608-897-8664
  • Fax:
Mailing address:
  • Phone: 608-897-8664
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number36891
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: