GRACE BLAKE
Individual Provider (NPI-1)
Active
Physician Assistant
Provider Information
- NPI Number
1124971395- Provider Type
- Individual Provider (NPI-1)
- Status
- Active
Contact & Location
- Address
- 1 E SUPERIOR ST STE 306, CHICAGO, IL, 606112595
- Phone
- (312) 754-9404
- Fax
- (312) 754-9402
Specialties & Taxonomies
Physician Assistant
Primary License: IL