MEDICARE: CAROL A BLUM M.D.

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
1	207L00000X	Anesthesiology Physician	R7N02	MO

Other Identifiers

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

General Provider Information

NPI Number	:	1013988674
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CAROL A BLUM M.D.

Provider Business Mailing Address
First Line	:	1515 W TRUMAN RD
Second Line	:	SUITE 108
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3436
Country	:	US
Telephone Number	:	816-461-3131
Fax Number	:	816-461-1662

Provider Business Practice Location Address
First Line	:	1515 W TRUMAN RD
Second Line	:	SUITE 108
City	:	INDEPENDENCE
State	:	MO
Zip	:	64050-3436
Country	:	US
Telephone Number	:	816-461-3131
Fax Number	:	816-461-1662

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/31/2006
Last Update Date	:	05/18/2012

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