Individual
BLAKE ANDREW WAREHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
507 N 17TH ST, MILWAUKEE, WI 53233-2104
(414) 288-5688
Mailing address
507 N 17TH ST, MILWAUKEE, WI 53233-2104
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.011867
IL
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
06/25/2025
Last updated
02/25/2026
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