Provider Demographics
NPI:1134855323
Name:BLAKE, MAKEDA (CPT, RMA)
Entity type:Individual
Prefix:
First Name:MAKEDA
Middle Name:
Last Name:BLAKE
Suffix:
Gender:F
Credentials:CPT, RMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2598 E SUNRISE BLVD STE 2104
Mailing Address - Street 2:
Mailing Address - City:FORT LAUDERDALE
Mailing Address - State:FL
Mailing Address - Zip Code:33304-3230
Mailing Address - Country:US
Mailing Address - Phone:305-741-1310
Mailing Address - Fax:954-827-0446
Practice Address - Street 1:1800 NE 173RD ST
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162
Practice Address - Country:US
Practice Address - Phone:305-741-1310
Practice Address - Fax:954-827-0446
Is Sole Proprietor?:No
Enumeration Date:2022-07-28
Last Update Date:2024-01-22
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246RP1900XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyPhlebotomy
No246RM2200XTechnologists, Technicians & Other Technical Service ProvidersTechnician, PathologyMedical Laboratory