Provider Demographics
NPI:1346224409
Name:BLOOM, STEVEN MARK (MD)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:MARK
Last Name:BLOOM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1935 BLUEGRASS AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40215-1179
Mailing Address - Country:US
Mailing Address - Phone:502-895-0040
Mailing Address - Fax:502-361-4488
Practice Address - Street 1:1935 BLUEGRASS AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1179
Practice Address - Country:US
Practice Address - Phone:502-895-0040
Practice Address - Fax:502-361-4488
Is Sole Proprietor?:No
Enumeration Date:2005-12-02
Last Update Date:2021-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY26932207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64269327Medicaid
IN300050485Medicaid
KY0365502Medicare ID - Type Unspecified
KY1454004Medicare ID - Type Unspecified
KY64269327Medicaid
IN331420BMedicare ID - Type Unspecified
IN100362500Medicaid