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NPI Code Detail

MEDICARE: WILLIAM THOMAS BLUM

MEDICARE: WILLIAM THOMAS BLUM
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
1390200000XStudent in an Organized Health Care Education/Training Program35.156644OH

General Provider Information

NPI Number : 1568102879
Entity Type Code : Individual
Provider Name (Legal Business Name) : WILLIAM THOMAS BLUM
Provider Business Mailing Address
First Line : 5310 WASHINGTON BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46220-3063
Country : US
Telephone Number : 317-435-7530
Fax Number :
Provider Business Practice Location Address
First Line : 3188 BELLEVUE AVE
Second Line :
City : CINCINNATI
State : OH
Zip : 45219-2369
Country : US
Telephone Number : 513-584-1000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2022
Last Update Date : 07/03/2026

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