Healthcare Provider Details

I. General information

NPI: 1760827273
Provider Name (Legal Business Name): BLAKE WILLIAM PERKINS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2013
Last Update Date: 11/13/2024
Certification Date: 11/13/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

IV. Provider business mailing address

801 S WASHINGTON ST
NAPERVILLE IL
60540-7430
US

V. Phone/Fax

Practice location:
  • Phone: 630-527-3000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number036145881
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMT203847
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: