Individual
DAVID ALAN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1500 E MEDICAL CENTER DR, 4TH FLOOR CLINIC B ROOM 4807, ANN ARBOR, MI 48109-4217
(734) 936-7030
Mailing address
3621 S STATE ST, 700 KMS PLACE, ANN ARBOR, MI 48108
(734) 936-2047
Taxonomy
Speciality
Code
Description
License number
State
208600000X
Surgery Physician
4301047893
MI
208800000X
Urology Physician
Primary
4301047893
MI
2088P0231X
Pediatric Urology Physician
4301047893
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1594500
—
MI
Enumeration date
09/28/2006
Last updated
04/24/2012
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