Individual
BLAKE STERLING SANFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3 ERIE CT, OAK PARK, IL 60302-2519
(708) 383-6200
Mailing address
180 N ADA ST APT 718, CHICAGO, IL 60607-1544
(615) 322-5000
(615) 322-5000
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
64817
TN
2083A0300X
Addiction Medicine (Preventive Medicine) Physician
64817
TN
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/05/2019
Last updated
07/07/2023
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