Individual
MICHAEL TODD BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
250 HOSPITAL PLACE, CENTRAL PENINSULA HOSPITAL, SOLDOTNA, AK 99669
(530) 208-8388
Mailing address
250 HOSPITAL PL, SOLDOTNA, AK 99669-6999
(907) 714-4444
Taxonomy
Speciality
Code
Description
License number
State
204R00000X
Electrodiagnostic Medicine Physician
20A11305
CA
207P00000X
Emergency Medicine Physician
Primary
7612
AK
207P00000X
Emergency Medicine Physician
DO1534
NV
Other
Enumeration date
08/05/2007
Last updated
10/07/2020
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