Organization
MARK F BLAKE MD, SC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. MARK F BLAKE MD (PRESIDENT)
(414) 963-0500
Entity
Organization
Contact information
Practice address
5201 N PORT WASHINGTON RD, MILWAUKEE, WI 53217-4902
(414) 963-0500
(414) 755-0743
Mailing address
5201 N PORT WASHINGTON RD, MILWAUKEE, WI 53217-4902
(414) 963-0500
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
—
—
Other
Enumeration date
06/18/2019
Last updated
06/18/2019
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