Individual
BLAKE CHILDRESS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
6140 N BROADWAY ST, CHICAGO, IL 60660-2538
(773) 564-9206
Mailing address
10403 PARMER CIR, FISHERS, IN 46038-5782
(317) 363-5420
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
085.011277
IL
363AM0700X
Medical Physician Assistant
—
—
Other
Enumeration date
04/21/2025
Last updated
06/12/2025
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