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NPI Code Detail

MEDICARE: DR. HENRY R BLOOM MD

MEDICARE: DR. HENRY R BLOOM MD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207Q00000XFamily Medicine Physician35-039371OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1003893025
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. HENRY R BLOOM MD
Provider Business Mailing Address
First Line : 20620 JOHN CARROLL BLVD
Second Line : SUITE 208
City : UNIVERSITY HEIGHTS
State : OH
Zip : 44118-4540
Country : US
Telephone Number : 216-321-9703
Fax Number : 216-321-9704
Provider Business Practice Location Address
First Line : 20620 JOHN CARROLL BLVD
Second Line : SUITE 208
City : UNIVERSITY HEIGHTS
State : OH
Zip : 44118-4540
Country : US
Telephone Number : 216-321-9703
Fax Number : 216-321-9704
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 07/16/2012

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