Individual
BLAKE R WARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1626 TUTTLE ST, BARABOO, WI 53913-1501
(608) 355-6868
(608) 356-6787
Mailing address
1626 TUTTLE ST, BARABOO, WI 53913-1501
(608) 355-6868
(608) 356-6787
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
4178-023
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1922527365
—
WI
Enumeration date
09/18/2017
Last updated
12/20/2020
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