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Individual
DALE W BLAISE
Active
Individual
DALE W BLAISE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036065426
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036065426
—
IL
01
—
3932056
BCBS
IL
01
—
7210895
AETNA
IL
01
—
8630880
MULTI PLAN
IL
Enumeration date
02/17/2006
Last updated
08/24/2022
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