Provider Demographics
NPI:1104884550
Name:BLOEMER, GARY F (MD)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:F
Last Name:BLOEMER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-636-4900
Mailing Address - Fax:502-636-4901
Practice Address - Street 1:3 AUDUBON PLAZA DR
Practice Address - Street 2:SUITE 430
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1300
Practice Address - Country:US
Practice Address - Phone:502-588-9490
Practice Address - Fax:502-272-5116
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY22975207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1050981OtherPASSPORT HEALTH PLAN
50027006OtherNOS/PHP
3759068000OtherNOS/PAD
KY64229750Medicaid
KY000000062049OtherANTHEM BCBS
000000642552OtherNOS/ANTHEM
000052152WOtherNOS/HUMANA
1944985OtherNOS/CIGNA
110585OtherNOS/SIHO
KY50027006OtherPASSPORT/ NOS
KY00533201Medicare PIN
1944985OtherNOS/CIGNA