Individual
LUDWIG BLAKE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
11105 NW 37TH ST, SUNRISE, FL 33351-7512
(754) 300-8501
Mailing address
11105 NW 37TH ST, SUNRISE, FL 33351-7512
Taxonomy
Speciality
Code
Description
License number
State
171W00000X
Contractor
Primary
—
—
Other
Enumeration date
03/19/2013
Last updated
03/19/2013
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