# MICHAEL A. BLOOM D.M.D. PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1033554845
- **Authorized official:** MRS. KATHY L. MARKS (OFFICE MANAGER)
- **Authorized official phone:** (208) 772-3583

## Contact information

- **Practice address:** 9928 N GOVERNMENT WAY, HAYDEN LAKE, ID 83835-9604
- **Practice address phone:** (208) 772-3583
- **Practice address fax:** (208) 772-3224
- **Mailing address:** PO BOX 425, HAYDEN LAKE, ID 83835-0425
- **Mailing address phone:** (208) 772-3583
- **Mailing address fax:** (208) 772-3224

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 302R00000X | Health Maintenance Organization | D3394 | ID | Yes |
| 302R00000X | Health Maintenance Organization | D3555 | ID | — |

## Other

- **Enumeration date:** 05/07/2013
- **Last updated:** 05/07/2013