MEDICARE: MICHAEL BLUTFIELD DPM

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	213ES0103X	Foot & Ankle Surgery Podiatrist	25MD00368100	NJ

General Provider Information

NPI Number	:	1427624923
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL BLUTFIELD DPM

Provider Business Mailing Address
First Line	:	1030 MCBRIDE AVE STE 103
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2535
Country	:	US
Telephone Number	:	973-638-1555
Fax Number	:

Provider Business Practice Location Address
First Line	:	1030 MCBRIDE AVE STE 103
Second Line	:
City	:	WOODLAND PARK
State	:	NJ
Zip	:	07424-2535
Country	:	US
Telephone Number	:	973-638-1555
Fax Number	:

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

Provider Enumeration Date	:	06/03/2021
Last Update Date	:	07/07/2022

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