NPIMap

Organization Active NPI

Mark F Blake MD, SC

  • Plastic Surgery Physician
  • Milwaukee, WI
National Provider Identifier
1639739030
Registry record updated Jun 18, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Plastic Surgery PhysicianTaxonomy code 208200000X
Legal business name
MARK F BLAKE MD, SC
Practice address
5201 N Port Washington Rd
Milwaukee, WI 53217-4902
Phone
(414) 963-0500
Fax
(414) 755-0743
NPI assigned
Jun 18, 2019
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 18, 2019

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

Authorized official

Name
Mr. Mark F Blake, MDNPI 1225074933
Title
President
Phone
(414) 963-0500

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Plastic Surgery PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208200000X Primary

Addresses

Primary practice location

5201 N Port Washington Rd
Milwaukee, WI 53217-4902

Mailing address

5201 N Port Washington Rd
Milwaukee, WI 53217-4902
Phone (414) 963-0500

National Provider Directory

National Provider Directory

Locations

5201 N Port Washington Rd
Glendale, WI 53217
Phone (414) 963-0500

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1560816000000",
    "number": "1639739030",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5201 N PORT WASHINGTON RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174902",
            "telephone_number": "414-963-0500"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5201 N PORT WASHINGTON RD",
            "city": "MILWAUKEE",
            "state": "WI",
            "postal_code": "532174902",
            "telephone_number": "414-963-0500",
            "fax_number": "414-755-0743"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MARK F BLAKE MD, SC",
        "organizational_subpart": "NO",
        "enumeration_date": "2019-06-18",
        "last_updated": "2019-06-18",
        "status": "A",
        "authorized_official_last_name": "BLAKE",
        "authorized_official_first_name": "MARK",
        "authorized_official_middle_name": "F",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "414-963-0500",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "208200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Plastic Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Milwaukee, WI

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 18, 2019; 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.