Michael Joseph Blake, MD | |
206 Alaska Frontage Rd, Belgrade, MT 59714-7909 | |
(406) 414-3334 | |
Not Available |
Full Name | Michael Joseph Blake |
---|---|
Gender | Male |
Speciality | Pediatrics |
Location | 206 Alaska Frontage Rd, Belgrade, Montana |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1578513701 | NPI | - | NPPES |
209287408 | Medicaid | MO | |
1578513701 | Medicaid | MT |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
208000000X | Pediatrics | 12120 (Montana) | Primary |
Entity Name | Bozeman Health Big Sky Medical Center Llc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1740659952 PECOS PAC ID: 7315256872 Enrollment ID: O20151023000110 |
Entity Name | Bozeman Health Deaconess Hospital |
---|---|
Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1619347390 PECOS PAC ID: 4688984164 Enrollment ID: O20151112002559 |
Mailing Address | Practice Location Address |
---|---|
Michael Joseph Blake, MD 915 Highland Blvd, Attn Pfs Credentialing, Bozeman, MT 59715-6902 Ph: (406) 414-5000 | Michael Joseph Blake, MD 206 Alaska Frontage Rd, Belgrade, MT 59714-7909 Ph: (406) 414-3334 |
Shaina Rogers, D.O. Pediatrics Medicare: Medicare Enrolled Practice Location: 206 Alaska Frontage Rd, Belgrade, MT 59714 Phone: 406-414-3334 | |
Katie Kidwell D'ardenne, MD Pediatrics Medicare: Medicare Enrolled Practice Location: 206 Alaska Frontage Rd, Belgrade, MT 59714 Phone: 406-414-3334 |