=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053107227
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MYLYFE HEALTH MA PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/15/2025
-----------------------------------------------------
Last Update Date | 11/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 145 WARD HILL AVE STE 100
-----------------------------------------------------
City | HAVERHILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01835-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-469-5933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 145 WARD HILL AVE STE 100
-----------------------------------------------------
City | HAVERHILL
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 01835-6928
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 844-469-5933
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT, TREASURER, SECRETARY
-----------------------------------------------------
Name | MICHAEL L BLUTE SR.
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 888-232-3120
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------