Blake Medical Care SC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

BLAKE MEDICAL CARE SC

Practice address

131 E Park Ave Ste 103
Libertyville, IL 60048-2858

Phone

(847) 984-3290

NPI assigned

Feb 22, 2022

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Dr. Katherine Blake, DO

Title

President

Phone

(847) 984-3290

Specialties & licenses 1

Addresses

Other names 1

• The Good Doc Direct Primary Care Doing business as

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1645488000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1645488000000",
    "number": "1013663749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1350 COUNTRY CT",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600481029",
            "telephone_number": "847-984-3290"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "131 E PARK AVE STE 103",
            "city": "LIBERTYVILLE",
            "state": "IL",
            "postal_code": "600482858",
            "telephone_number": "847-984-3290"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BLAKE MEDICAL CARE SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-02-22",
        "last_updated": "2022-02-22",
        "certification_date": "2022-02-22",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "KATHERINE",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "847-984-3290",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DO"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "The Good Doc Direct Primary Care",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Sophia Bilikovsky, DACM
• Emma Billy
• Bradley Binder
• Jonathan Birnberg, MD
• Amy L Blais, D.O.
• Katherine M Blake, D.O.
• Crandell W Bliss, L.C.P.C.
• Jaime Block, AUD
• Lisa S Block, LCPC
• Misty Lynn Blomquist, L.AC

• Family Medicine Physician in Libertyville, IL
• Providers in Libertyville, IL by specialty
• Family Medicine Physician in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 22, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.