| Michael A Blum Do Pa | |
|
579 Nw Lake Whitney Place Suite 101 Port Saint Lucie FL 34986-1622 | |
| (772) 249-0260 | |
| (772) 249-0137 |
| Full Name | Michael A Blum Do Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 579 Nw Lake Whitney Place, Port Saint Lucie, Florida |
| Authorized Official Name and Position | Michael Allan Blum (PRESIDENT AND CEO) |
| Authorized Official Contact | 7722490260 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Michael A Blum Do Pa 579 Nw Lake Whitney Place Suite 101 Port Saint Lucie FL 34986-1622 Ph: (772) 249-0260 | Michael A Blum Do Pa 579 Nw Lake Whitney Place Suite 101 Port Saint Lucie FL 34986-1622 Ph: (772) 249-0260 |
| NPI Number | 1770876120 |
|---|---|
| Provider Enumeration Date | 05/18/2011 |
| Last Update Date | 03/15/2022 |
| Medicare PECOS PAC ID | 2466621370 |
|---|---|
| Medicare Enrollment ID | O20110810000668 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1770876120 | NPI | - | NPPES |
| 014151100 | Medicaid | FL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | OS7680 (Florida) | Primary |
| Provider Name | Michael A Blum |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1922082965 PECOS PAC ID: 7214065242 Enrollment ID: I20100512000159 |
| Provider Name | Melanie J De Guzman |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1699128736 PECOS PAC ID: 9234427816 Enrollment ID: I20161014000209 |
| Provider Name | Sandra Velasquez |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1710401104 PECOS PAC ID: 9830455237 Enrollment ID: I20171116002665 |
| Provider Name | Jeffrey Lynn Zellers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1508374992 PECOS PAC ID: 1456612795 Enrollment ID: I20180228002245 |
| Provider Name | Ashlee M Myers |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1760080766 PECOS PAC ID: 9234540386 Enrollment ID: I20201123000784 |
| Provider Name | Ashley Megan Beck |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689398653 PECOS PAC ID: 8921477746 Enrollment ID: I20221216001399 |
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