Provider Demographics
NPI:1053075325
Name:ROWE, BLAKE MICHAEL (PA-C)
Entity Type:Individual
Prefix:
First Name:BLAKE
Middle Name:MICHAEL
Last Name:ROWE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:1425 NORTH HUNT CLUB ROAD
Mailing Address - Street 2:STE 100
Mailing Address - City:GURNEE
Mailing Address - State:IL
Mailing Address - Zip Code:60031-2632
Mailing Address - Country:US
Mailing Address - Phone:847-548-2200
Mailing Address - Fax:847-548-2865
Practice Address - Street 1:1425 N HUNT CLUB RD
Practice Address - Street 2:STE 100
Practice Address - City:GURNEE
Practice Address - State:IL
Practice Address - Zip Code:60031-2632
Practice Address - Country:US
Practice Address - Phone:847-548-2200
Practice Address - Fax:847-548-2865
Is Sole Proprietor?:No
Enumeration Date:2021-10-23
Last Update Date:2024-03-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085009520363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant