Individual
DR. MICHAEL C. BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2018 W CLINCH AVE, KNOXVILLE, TN 37916-2301
(865) 541-8000
Mailing address
1431 CENTERPOINT BLVD, SUITE 100, KNOXVILLE, TN 37932-1984
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
29085
TN
208000000X
Pediatrics Physician
MD29085
TN
2080P0204X
Pediatric Emergency Medicine (Pediatrics) Physician
MD29085
TN
208M00000X
Hospitalist Physician
Primary
29085
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3124793
BLUE CROSS
TN
05
—
3897731
—
TN
05
—
64712771
—
KY
Enumeration date
06/14/2006
Last updated
07/10/2015
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