Individual
NATHAN MICHAEL BLOOM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4921 W 18TH ST, LAWRENCE, KS 66047-2090
(785) 830-0100
(785) 830-0115
Mailing address
4921 W 18TH ST, LAWRENCE, KS 66047-2090
(785) 830-0100
(785) 830-0115
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
0432319
KS
207Q00000X
Family Medicine Physician
9406871
KS
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200672020A
—
KS
Enumeration date
07/02/2007
Last updated
12/06/2022
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