MEDICARE: NOAH M BLUM DPM PA

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	213E00000X	Podiatrist	P02942	FL

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	:	1598987240
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NOAH M BLUM DPM PA

Provider Business Mailing Address
First Line	:	2316 NEBRASKA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4824
Country	:	US
Telephone Number	:	772-489-4343
Fax Number	:	772-489-4543

Provider Business Practice Location Address
First Line	:	2316 NEBRASKA AVE
Second Line	:
City	:	FORT PIERCE
State	:	FL
Zip	:	34950-4824
Country	:	US
Telephone Number	:	772-489-4343
Fax Number	:	772-489-4543

Authorized Official
Title or Position	:	OWNER PHYSICIAN
Name	:	NOAH M BLUM
Credential	:	DPM
Telephone Number	:	772-489-4343

Provider Enumeration Date	:	05/03/2007
Last Update Date	:	03/09/2023

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