Individual
BRADLEY JOSEPH BLAKEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
201 S 14TH ST, HERRIN, IL 62948-3631
(618) 942-2171
(618) 351-4919
Mailing address
405 W JACKSON STREET, SIH MEDICAL GROUP ANESTHESIOLOGY, CARBONDALE, IL 62901
(618) 457-5200
(618) 529-0449
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
209004624
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
214881
GROUP PTAN
IL
Enumeration date
10/05/2005
Last updated
05/14/2021
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