Provider Demographics
NPI:1356617252
Name:BLAKELEY, KAREN (DVM)
Entity type:Individual
Prefix:DR
First Name:KAREN
Middle Name:
Last Name:BLAKELEY
Suffix:
Gender:F
Credentials:DVM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 W JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:MACOMB
Mailing Address - State:IL
Mailing Address - Zip Code:61455-2012
Mailing Address - Country:US
Mailing Address - Phone:309-833-2365
Mailing Address - Fax:
Practice Address - Street 1:722 W JACKSON ST
Practice Address - Street 2:
Practice Address - City:MACOMB
Practice Address - State:IL
Practice Address - Zip Code:61455-2012
Practice Address - Country:US
Practice Address - Phone:309-833-2365
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-26
Last Update Date:2012-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL090-007699174M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174M00000XOther Service ProvidersVeterinarian
Provider Identifiers
StateIdentifier IDID TypeIssuer
00000OtherNONE