Individual
JOSHUA A BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
6308 8TH AVE, SUITE 2000, KENOSHA, WI 53143-5031
(262) 653-5360
(262) 653-5357
Mailing address
6308 8TH AVE, SUITE 2000, KENOSHA, WI 53143-5031
(262) 653-5360
(262) 653-5357
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
29321
WI
207RC0200X
Critical Care Medicine (Internal Medicine) Physician
29321
WI
207RP1001X
Pulmonary Disease Physician
Primary
29321
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
110105435
MEDICARE RR
WI
05
—
31437500
—
WI
Enumeration date
05/27/2006
Last updated
11/13/2012
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