Individual
STEPHEN MICHAEL BLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1001 NW LOVEJOY ST, UNIT 706, PORTLAND, OR 97209-3566
(503) 719-6544
(866) 898-2159
Mailing address
23625 COMMERCE PARK, SUITE 204, BEACHWOOD, OH 44122
(216) 255-5743
(866) 735-3451
Taxonomy
Speciality
Code
Description
License number
State
2085N0700X
Neuroradiology Physician
036077134
IL
2085R0202X
Diagnostic Radiology Physician
Primary
0036077134
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00598870
—
NY
05
—
036077134
—
IL
05
—
1451169
—
LA
01
—
1861441560
TRICARE NORTH
—
05
—
235428
—
AZ
05
—
2749477
—
OH
05
—
402417601
—
MD
05
—
402417602
—
MD
05
—
808256100
—
ID
05
—
8529588
—
WA
01
—
P00922031
RAILROAD MCR
OR
Enumeration date
05/09/2006
Last updated
03/07/2023
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