Basic Information
| Provider Information | |||||||||
| NPI: | 1801951942 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BLAKE | ||||||||
| FirstName: | SARA | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | DEPT CH14389 | ||||||||
| Address2: | |||||||||
| City: | PALATINE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 600554389 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955307 | ||||||||
| FaxNumber: | 7852707646 | ||||||||
| Practice Location | |||||||||
| Address1: | 634 SW MULVANE STREET | ||||||||
| Address2: | SUITE 209 | ||||||||
| City: | TOPEKA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 666060000 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852955330 | ||||||||
| FaxNumber: | 7852955355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/27/2006 | ||||||||
| LastUpdateDate: | 08/17/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207V00000X | 6381 | KS | N | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | 207V00000X | 04-33845 | KS | Y | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology |
No ID Information.