Basic Information
| Provider Information | |||||||||
| NPI: | 1558417345 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLUM | ||||||||
| FirstName: | KEITH | ||||||||
| MiddleName: | S | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | DO | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7271 WEST SAHARA | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891172753 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022404090 | ||||||||
| FaxNumber: | 7022404091 | ||||||||
| Practice Location | |||||||||
| Address1: | 7271 WEST SAHARA | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89117 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7022404090 | ||||||||
| FaxNumber: | 7022404091 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/26/2007 | ||||||||
| LastUpdateDate: | 02/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207T00000X | 1121 | NV | Y | Allopathic & Osteopathic Physicians | Neurological Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100502549 | 05 | NV | MEDICAID | 1456305995 | 01 | NV | BCBS | OTHER |