MEDICARE: DR. KATHERINE M BLAKE D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	125-061735	IL
2	207QB0002X	Obesity Medicine (Family Medicine) Physician	036136377	IL
3	207Q00000X	Family Medicine Physician	64086	WI
4	207Q00000X	Family Medicine Physician	036136377	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225304322
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE M BLAKE D.O.

Provider Business Mailing Address
First Line	:	131 E PARK AVE STE 103
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-2858
Country	:	US
Telephone Number	:	847-984-3290
Fax Number	:	847-255-2015

Provider Business Practice Location Address
First Line	:	131 E PARK AVE STE 103
Second Line	:
City	:	LIBERTYVILLE
State	:	IL
Zip	:	60048-2858
Country	:	US
Telephone Number	:	847-984-3290
Fax Number	:	847-255-2015

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/22/2012
Last Update Date	:	03/10/2026

Similar Medicare Providers

1013663749 — BLAKE MEDICAL CARE SC
Practice Location Address:

131 E PARK AVE STE 103
LIBERTYVILLE, IL
60048-2858

Practice Phone: 847-984-3290
Practice Fax:

1134863749 — NORTHSTAR REHAB PAIN CLINICS PLLC
Practice Location Address:

131 E PARK AVE STE 103
LIBERTYVILLE, IL
60048-2858

Practice Phone: 847-393-6246
Practice Fax:

1043161060 — MODERN PAIN MANAGEMENT SC
Practice Location Address:

1795 N BUTTERFIELD RD STE 108
LIBERTYVILLE, IL
60048-1212

Practice Phone: 773-818-1544
Practice Fax:

1609121219 — DR. MIKIN VIRENDRA PATEL MD
Practice Location Address:

1870 W WINCHESTER RD STE 146
LIBERTYVILLE, IL
60048-5359

Practice Phone: 847-584-3959
Practice Fax:

1477303691 — DR. KATHERINE ADA MURZANSKI DNP, AGPCNP-BC
Practice Location Address:

1870 W WINCHESTER RD STE 146
LIBERTYVILLE, IL
60048-5359

Practice Phone: 847-584-3959
Practice Fax:

1790917557 — OSMANUDDIN SYED AHMED MD
Practice Location Address:

1870 W WINCHESTER RD STE 146
LIBERTYVILLE, IL
60048-5359

Practice Phone: 847-584-3959
Practice Fax:

Directions to “ DR. KATHERINE M BLAKE D.O.” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.