1801951942 NPI number — SARA B BLAKE MD

Table of content: SARA B BLAKE MD (NPI 1801951942)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801951942 NPI number — SARA B BLAKE MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BLAKE
Provider First Name:
SARA
Provider Middle Name:
B
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801951942
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/17/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT CH14389
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PALATINE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60055-4389
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
785-295-5307
Provider Business Mailing Address Fax Number:
785-270-7646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
634 SW MULVANE STREET
Provider Second Line Business Practice Location Address:
SUITE 209
Provider Business Practice Location Address City Name:
TOPEKA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66606-0000
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
785-295-5330
Provider Business Practice Location Address Fax Number:
785-295-5355
Provider Enumeration Date:
12/27/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207V00000X , with the licence number:  6381 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207V00000X , with the licence number: 04-33845 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)