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Individual

DR. ALFONSO A BLUM

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.

Contact information

Practice address
4035 ELM STREET, EAST CHICAGO, IN 46312-3042
(219) 398-9840
(219) 398-9845
Mailing address
9660 WICKER AVENUE, ST JOHN, IN 46373-9487
(219) 226-2203
(219) 226-2202

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01062815A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
01062815A
PHYSICIAN LICENSE
IN
Enumeration date
02/22/2007
Last updated
07/13/2010
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