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Individual

MICHAEL JOSEPH BLAKE

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
206 ALASKA FRONTAGE RD, BELGRADE, MT 59714-7909
(406) 414-3334
Mailing address
915 HIGHLAND BLVD, ATTN PFS CREDENTIALING, BOZEMAN, MT 59715-6902
(406) 414-5000

Taxonomy

Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
12120
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
1578513701
MT
05
209287408
MO
Enumeration date
05/10/2006
Last updated
04/15/2025
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