| Blake Medical Care Sc | |
|
131 E Park Ave Ste 103 Libertyville IL 60048-2858 | |
| (847) 984-3290 | |
| Not Available |
| Full Name | Blake Medical Care Sc |
|---|---|
| Speciality | Family Medicine |
| Location | 131 E Park Ave Ste 103, Libertyville, Illinois |
| Authorized Official Name and Position | Katherine Blake (PRESIDENT) |
| Authorized Official Contact | 8479843290 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blake Medical Care Sc 1350 Country Ct Libertyville IL 60048-1029 Ph: (847) 984-3290 | Blake Medical Care Sc 131 E Park Ave Ste 103 Libertyville IL 60048-2858 Ph: (847) 984-3290 |
| NPI Number | 1013663749 |
|---|---|
| Provider Enumeration Date | 02/22/2022 |
| Last Update Date | 02/22/2022 |
| Medicare PECOS PAC ID | 4486032331 |
|---|---|
| Medicare Enrollment ID | O20220604000332 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1013663749 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| Provider Name | Katherine M Blake |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1225304322 PECOS PAC ID: 0042524480 Enrollment ID: I20180322002510 |
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