Provider Demographics
NPI:1073347787
Name:BLUHM, KYLE ALAN
Entity type:Individual
Prefix:
First Name:KYLE
Middle Name:ALAN
Last Name:BLUHM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1443 W BERTEAU AVE APT BSMT
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-1783
Mailing Address - Country:US
Mailing Address - Phone:651-231-0197
Mailing Address - Fax:
Practice Address - Street 1:1443 W BERTEAU AVE APT BSMT
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-1783
Practice Address - Country:US
Practice Address - Phone:651-231-0197
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist