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Individual
DR. KATHLEEN ACKMAN BLAKE
Active
Individual
DR. KATHLEEN ACKMAN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
0360647112
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0360647112
—
IL
01
—
L77523
MEDICARE PTAN
IL
Enumeration date
01/12/2006
Last updated
07/21/2010
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