Individual
DR. KENNETH EVAN BLOOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DPM
Contact information
Practice address
137 PROFESSIONAL PARK DR, SUITE C, MOORESVILLE, NC 28117-6540
(704) 662-8336
(704) 662-8525
Mailing address
137 PROFESSIONAL PARK DR, SUITE C, MOORESVILLE, NC 28117-6540
(704) 662-8336
(704) 662-8525
Taxonomy
Speciality
Code
Description
License number
State
213E00000X
Podiatrist
414
NC
213ES0103X
Foot & Ankle Surgery Podiatrist
Primary
414
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
790800H
—
NC
Enumeration date
09/21/2005
Last updated
08/07/2023
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