Individual
BLAKE ALEXANDER WEIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
611 W PARK ST, URBANA, IL 61801
(217) 383-3311
Mailing address
611 W. PARK ST., FAPC, URBANA, IL 61801
(217) 902-5291
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
2013018930
MO
207R00000X
Internal Medicine Physician
2014034042
MO
2085R0202X
Diagnostic Radiology Physician
Primary
036150541
IL
2085R0202X
Diagnostic Radiology Physician
2014034042
MO
390200000X
Student in an Organized Health Care Education/Training Program
61241
CT
Other
Enumeration date
06/26/2013
Last updated
12/04/2019
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