Provider Demographics
NPI:1447294343
Name:BLUMENSTEIN, HAROLD I (MD)
Entity type:Individual
Prefix:
First Name:HAROLD
Middle Name:I
Last Name:BLUMENSTEIN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4200 FASHION SQUARE BLVD
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48603-1291
Mailing Address - Country:US
Mailing Address - Phone:989-797-3083
Mailing Address - Fax:989-799-6475
Practice Address - Street 1:4200 FASHION SQUARE BLVD
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48603-1291
Practice Address - Country:US
Practice Address - Phone:989-797-3083
Practice Address - Fax:989-799-6475
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI43010271672085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4690789Medicaid
MI4690789Medicaid
A78433Medicare UPIN