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NPI Code Detail

MEDICARE: BLAKE ANDREW WAREHAM

MEDICARE: BLAKE ANDREW WAREHAM
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
1363A00000XPhysician Assistant085.011867IL

General Provider Information

NPI Number : 1518855907
Entity Type Code : Individual
Provider Name (Legal Business Name) : BLAKE ANDREW WAREHAM
Provider Business Mailing Address
First Line : 507 N 17TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2104
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 507 N 17TH ST
Second Line :
City : MILWAUKEE
State : WI
Zip : 53233-2104
Country : US
Telephone Number : 414-288-5688
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/25/2025
Last Update Date : 02/25/2026

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Directions to “ BLAKE ANDREW WAREHAM ” Practice Location

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