Basic Information
| Provider Information | |||||||||
| NPI: | 1730111329 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLUM | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2650 RIDGE AVE RM 1223 | ||||||||
| Address2: | |||||||||
| City: | EVANSTON | ||||||||
| State: | IL | ||||||||
| PostalCode: | 602011700 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8475702040 | ||||||||
| FaxNumber: | 8477335315 | ||||||||
| Practice Location | |||||||||
| Address1: | 9600 GROSS POINT RD | ||||||||
| Address2: | |||||||||
| City: | SKOKIE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600761214 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8476779600 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/06/2006 | ||||||||
| LastUpdateDate: | 03/28/2018 | ||||||||
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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 | 207L00000X | 036-085915 | IL | Y | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | 036-085915 | IL | N | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 363117700 | 01 | IL | OTHER INS PROVIDER NUMBER | OTHER | 603710503 | 01 | IL | US DEPARTMENT OF LABOR | OTHER | 050025825 | 01 | IL | MEDICARE RAILROAD | OTHER | N276157 | 01 | IL | WELLCARE CLAIMS | OTHER | 036-085915 | 05 | IL | MEDICAID | 100367930 | 01 | IL | INDIANA MEDICAID | OTHER | 363117700006 | 01 | IL | TRICARE | OTHER |