Provider Demographics
NPI:1588060875
Name:BLOOM REPRODUCTIVE INSTITUTE, PLLC
Entity type:Organization
Organization Name:BLOOM REPRODUCTIVE INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:BEHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-434-6565
Mailing Address - Street 1:8415 N PIMA RD
Mailing Address - Street 2:STE 290
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85258-4480
Mailing Address - Country:US
Mailing Address - Phone:480-434-6565
Mailing Address - Fax:480-383-6426
Practice Address - Street 1:8415 N PIMA RD
Practice Address - Street 2:STE 290
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85258-4480
Practice Address - Country:US
Practice Address - Phone:480-434-6565
Practice Address - Fax:480-383-6426
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-13
Last Update Date:2014-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ42873207VE0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207VE0102XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyReproductive EndocrinologyGroup - Single Specialty