Provider Demographics
NPI:1760524417
Name:BLAKE, JAMES W (MD)
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:W
Last Name:BLAKE
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Gender:M
Credentials:MD
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Mailing Address - Street 1:3601 W 13 MILE RD
Mailing Address - Street 2:DIVISION OF CARDIOLOGY
Mailing Address - City:ROYAL OAK
Mailing Address - State:MI
Mailing Address - Zip Code:48073-6712
Mailing Address - Country:US
Mailing Address - Phone:248-898-4163
Mailing Address - Fax:248-898-5596
Practice Address - Street 1:3601 W 13 MILE RD
Practice Address - Street 2:DIVISION OF CARDIOLOGY
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6712
Practice Address - Country:US
Practice Address - Phone:248-898-4163
Practice Address - Fax:248-898-5596
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
MI4301085340207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease