Individual
MATTHEW BLAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
6100 S LOUISE AVE STE 2100, SIOUX FALLS, SD 57108-6021
(605) 504-1100
Mailing address
911 E 20TH ST STE 300, SIOUX FALLS, SD 57105-1045
(605) 322-1300
(605) 322-1301
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101252248
VA
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
Primary
10419
SD
207XX0005X
Sports Medicine (Orthopaedic Surgery) Physician
49155
KY
Other
Enumeration date
05/17/2007
Last updated
10/31/2019
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