Blake, Kenneth D

Blake, Kenneth D is an individual health care provider with primary practice located at 10103 Ridgegate Pkwy Suite 208, Lone Tree CO 80124-5520. He recently has only one registered license in Allopathic & Osteopathic Physicians / Colon & Rectal Surgery, which is considered as his primary health care specialty. Blake, Kenneth D can be contacted via phone (303) 535-5350.

Contact Information

Primary practice address
10103 Ridgegate Pkwy Suite 208 Lone Tree CO 80124-5520
Phone: (303) 535-5350
Fax: (303) 535-5353
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 41202 Colorado

Profile Details

NPI number 1174622070
LBN Legal business name Blake, Kenneth D
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 21st, 2006
Last updated Jun 6th, 2023 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1174622070 NPPES
Colorado MEDICAID 04305876

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