Organization
MICHAEL V BLOOM PHD LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MICHAEL V BLOOM PHD (PSYCHOLOGIST)
(269) 345-0669
Entity
Organization
Contact information
Practice address
7920 KIRKLAND CT, PORTAGE, MI 49024-4974
(269) 345-0669
(269) 345-5354
Mailing address
PO BOX 3272, SAGINAW, MI 48605-3272
(989) 797-1400
(989) 797-4077
Taxonomy
Speciality
Code
Description
License number
State
103T00000X
Psychologist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
6301017079
STATE LICENSE
MI
Enumeration date
09/17/2019
Last updated
09/25/2020
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