Basic Information
| Provider Information | |||||||||
| NPI: | 1760413389 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLOOM | ||||||||
| FirstName: | ROBERT | ||||||||
| MiddleName: | E. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 22301 FOSTER WINTER DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485520620 | ||||||||
| FaxNumber: | 2485520286 | ||||||||
| Practice Location | |||||||||
| Address1: | 22301 FOSTER WINTER DR | ||||||||
| Address2: | 2ND FLOOR | ||||||||
| City: | SOUTHFIELD | ||||||||
| State: | MI | ||||||||
| PostalCode: | 480753707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2485520620 | ||||||||
| FaxNumber: | 2485520286 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/05/2006 | ||||||||
| LastUpdateDate: | 02/18/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | RB041036 | MI | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology |
ID Information
| ID | Type | State | Issuer | Description | 104130943 | 05 | MI | MEDICAID |