Jacob, Michael Blake

Jacob, Michael Blake is an individual health care provider with primary practice located at 2855 Campus Dr , Plymouth MN 55441-2649. He recently has 2 registered licenses in different health care specialties including Allopathic & Osteopathic Physicians / Sports Medicine, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant. Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant is his primary health care specialty. Jacob, Michael Blake can be contacted via phone (763) 577-7000.

Contact Information

Primary practice address
2855 Campus Dr Plymouth MN 55441-2649
Phone: (763) 577-7000
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Sports Medicine 207XX0005X 12595 Minnesota
Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant 363A00000X 12593 Minnesota

Profile Details

NPI number 1821502154
LBN Legal business name Jacob, Michael Blake
Credentials Physician's Assistant Certified (PA-C)
Entity Individual
Sole proprietor 1 No
Enumeration date Nov 22nd, 2017
Last updated Mar 11th, 2021 - about 4 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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