Individual
DR. KATHERINE M BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
131 E PARK AVE STE 103, LIBERTYVILLE, IL 60048-2858
(847) 984-3290
(847) 255-2015
Mailing address
131 E PARK AVE STE 103, LIBERTYVILLE, IL 60048-2858
(847) 984-3290
(847) 255-2015
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036136377
IL
207Q00000X
Family Medicine Physician
125-061735
IL
207Q00000X
Family Medicine Physician
64086
WI
207QB0002X
Obesity Medicine (Family Medicine) Physician
036136377
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100046359
—
WI
Enumeration date
03/22/2012
Last updated
03/10/2026
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