MEDICARE: HOPE MEDICAL SC

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	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1972558757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOPE MEDICAL SC

Provider Business Mailing Address
First Line	:	2310 YORK ST
Second Line	:	SUITE 3C
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2310 YORK ST
Second Line	:	SUITE 3C
City	:	BLUE ISLAND
State	:	IL
Zip	:	60406-2411
Country	:	US
Telephone Number	:	708-388-3022
Fax Number	:

Authorized Official
Title or Position	:	OWNER / PHYSICIAN
Name	:	WAYNE S BLAKE
Credential	:	DO
Telephone Number	:	708-388-3022

Provider Enumeration Date	:	05/23/2006
Last Update Date	:	08/22/2020

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Directions to “HOPE MEDICAL SC ” Practice Location

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