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NPI Code Detail

MEDICARE: DR. KEITH S BLUM DO

MEDICARE: DR. KEITH S BLUM DO
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
1207T00000XNeurological Surgery Physician1121NV

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
21456305995OTHERNVBCBS

General Provider Information

NPI Number : 1558417345
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. KEITH S BLUM DO
Provider Business Mailing Address
First Line : 7271 WEST SAHARA
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89117-2753
Country : US
Telephone Number : 702-240-4090
Fax Number : 702-240-4091
Provider Business Practice Location Address
First Line : 7271 WEST SAHARA
Second Line : SUITE 100
City : LAS VEGAS
State : NV
Zip : 89117
Country : US
Telephone Number : 702-240-4090
Fax Number : 702-240-4091
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/26/2007
Last Update Date : 02/14/2020

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