Individual
DR. BLAKE BASHOR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O
Contact information
Practice address
1032 E SUMNER ST, HARTFORD, WI 53027-1608
(262) 673-2300
Mailing address
PO BOX 735044, CHICAGO, IL 60673-5044
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
2779-021
WI
207P00000X
Emergency Medicine Physician
OS018472
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100248198
—
WI
Enumeration date
06/23/2015
Last updated
10/18/2023
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