Individual
JUDI ELLEN BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
2100 PFINGSTEN RD STE 3001, GLENVIEW, IL 60026-1301
(847) 657-5815
(847) 657-3724
Mailing address
2100 PFINGSTEN RD STE 3001, GLENVIEW, IL 60026-1301
(847) 657-5815
(847) 657-3724
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
085009438
IL
363AS0400X
Surgical Physician Assistant
Primary
085009438
IL
Other
Enumeration date
02/25/2022
Last updated
08/05/2024
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