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General NPI Number Information
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NPI Number | 1467525303
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Entity Type | Organization
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Legal Business Name | STEVE BLICBLUM M D P A
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Dates
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Enumeration Date | 11/16/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 900 GRIFFIN RD
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City | LAKELAND
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State | FL
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Zip | 33805-2442
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Country | US
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Telephone | 863-686-1711
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Fax | 813-681-5403
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Provider Business Mailing Address
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Address Line | PO BOX 852
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City | BRANDON
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State | FL
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Zip | 33509-0852
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Country | US
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Telephone | 813-685-5459
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Fax | 813-681-5403
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Authorized Official
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Title or Position | GROUP ADMINISTRATOR
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Name | MRS. ILLENE BLICBLUM
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Credential |
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Telephone | 813-685-5459
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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