Kathleen Ackman Blake, MD
Individual provider Active NPI Ophthalmology Physician · Hinsdale, IL
NPI 1497734966 · NPPES record last updated Jul 21, 2010
Key facts
- NPI
- 1497734966
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Ophthalmology Physician 207W00000X
- License
- 0360647112 (IL)
- Practice address
- 126 W First Street
Hinsdale, IL 60521 - Phone
- (630) 325-5200
- Fax
- (630) 325-5569
- NPI assigned
- Jan 12, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0360647112 | IL | MD | Ophthalmology Physician |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Ophthalmology Physician | 207W00000X | 0360647112 | IL | Yes |
Addresses
Primary practice location
126 W First Street
Hinsdale, IL 60521
Mailing address
126 W First Street
Hinsdale, IL 60521
Phone (630) 325-5200
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| L77523 | Other | IL | MEDICARE PTAN |
| 0360647112 | Medicaid | IL |
Other providers in Hinsdale, IL
- Abayomi Adeyemi MD SC
- Sabrina Abbate
- Abchild PCP, LLC
- Erik Lyle Abramson
- Ac Dermatology, LTD.
- Acu Health Center, LTD.
- Adam R Winckler DDS PC
- Adamo Diagnostics, LLC
- Adamo Eye Care, P.C.
- Treacy Adamo
All providers in Hinsdale, IL · Ophthalmology Physician in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 21, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.