MEDICARE: BLAKE DIALYSIS LLC

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	261QE0700X	End-Stage Renal Disease (ESRD) Treatment Clinic/Center

General Provider Information

NPI Number	:	1659714558
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLAKE DIALYSIS LLC

Provider Business Mailing Address
First Line	:	5200 VIRGINIA WAY
Second Line	:	L&C DEPT
City	:	BRENTWOOD
State	:	TN
Zip	:	37027-7569
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4176 N 56TH ST
Second Line	:
City	:	MILWAUKEE
State	:	WI
Zip	:	53216-1276
Country	:	US
Telephone Number	:	414-445-2119
Fax Number	:	414-445-3794

Authorized Official
Title or Position	:	VP LICENSURE & CERTIFICATION
Name	:	SAMUEL T WEY
Credential	:
Telephone Number	:	615-341-6641

Provider Enumeration Date	:	04/10/2013
Last Update Date	:	03/16/2026

Similar Medicare Providers

1467312397 — A GRANDMOTHER'S TOUCH
Practice Location Address:

4429 W HOWIE PL
MILWAUKEE, WI
53216-2426

Practice Phone: 414-607-2314
Practice Fax:

1316895329 — HAPPY TO HELP TRANSPORTATION LLC
Practice Location Address:

4328 N 70TH ST
MILWAUKEE, WI
53216-1168

Practice Phone: 414-241-7416
Practice Fax:

1093153199 — ADELINE HOOKER CSAC
Practice Location Address:

4906 W FOND DU LAC AVE
MILWAUKEE, WI
53216-2325

Practice Phone: 414-449-4777
Practice Fax: 414-270-2971

1851249627 — CHRISTINE WIESE LPC-IT
Practice Location Address:

4906 W FOND DU LAC AVE
MILWAUKEE, WI
53216-2325

Practice Phone: 414-449-4777
Practice Fax: 414-270-2971

1790633279 — GOING YOUR WAY TRANSPORTATION LLC
Practice Location Address:

3856 N 44TH ST APT 2
MILWAUKEE, WI
53216-2419

Practice Phone: 262-873-7346
Practice Fax:

1639025794 — SOMEBODY CARES AFH LLC
Practice Location Address:

3528 N 42ND ST
MILWAUKEE, WI
53216-3439

Practice Phone: 414-345-0440
Practice Fax:

Directions to “BLAKE DIALYSIS LLC ” 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.