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Individual

DR. MICHAEL LEONARD BLOOMQUIST

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PHD, LP

Contact information

Practice address
UNIVERSITY OF MINNESOTA PHYSICIANS, 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST, MINNEAPOLIS, MN 55454
(612) 273-8700
Mailing address
UNIVERSITY OF MINNESOTA PHYSICIANS, 2312 SOUTH 6TH STREET, SUITE F256 / 2B WEST, MINNEAPOLIS, MN 55454
(612) 273-9800

Taxonomy

Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
LP 1196
MN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
0920001
PREFERRED ONE
MN
01
112423
UCARE
MN
01
61-39497
MEDICA CHOICE & PRIMARY
MN
01
768028
ARAZ
MN
01
9G743BL
BCBS
MN
01
C626
CHAMPUS/TRIWEST
MN
01
HP29376
HEALTHPARTNERS
MN
Enumeration date
06/22/2006
Last updated
07/09/2007
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