| NPI | 1215559331 |
|---|---|
| Doing Business As | JON K. BLAKE MD |
| Entity Type | Organization |
| Authorized Contact | JON BLAKE Authorized Official/Physician 765-674-7889 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208D00000X General Practice |
| Enumeration Date | 2020-05-12 |
| Last Update Date | 2020-05-12 |