Provider Demographics
NPI:1841683497
Name:PLATT, BLAKE JOSEPH
Entity type:Individual
Prefix:
First Name:BLAKE
Middle Name:JOSEPH
Last Name:PLATT
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 E OHIO ST
Mailing Address - Street 2:APT 2508
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60611-3375
Mailing Address - Country:US
Mailing Address - Phone:219-781-6265
Mailing Address - Fax:
Practice Address - Street 1:345 E OHIO ST
Practice Address - Street 2:APT 2508
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60611-3375
Practice Address - Country:US
Practice Address - Phone:219-781-6265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-06
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program