Individual
BRENDA A BLOHM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2817 NEW PINERY RD, DIVINE SAVIOR HEALTHCARE INC, PORTAGE, WI 53901-9257
(608) 745-4598
(608) 745-6242
Mailing address
PO BOX 387, DIVINE SAVIOR HEALTHCARE INC, PORTAGE, WI 53901-0387
(608) 745-4598
(608) 745-6242
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
38801020
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
32383000
—
WI
Enumeration date
11/22/2005
Last updated
10/14/2011
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