WENDELL O BLAKE MD PA
Osteopathic Medicine in Lakeland, FL

License number
Florida ME0016779
Category
Osteopathic Medicine
Type
General Practice
Owner
Name: WENDELL O BLAKE M.D.
Title: PRESIDENT
Phone: (863) 683-5567
Address
Address
505 Martin Luther King Jr Ave SUITE 2, Lakeland, FL 33815
National Provider ID: 1700213972
LicenseFiles verified this license of Nov 7, 2017 at the National Plan and Provider Enumeration System.

Organization information

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Wendell O. Blake, M.D., PA

505 Martin Luther King Jr Ave, Lakeland, FL 33815

Registration:
Nov 9, 2012
State ID:
P12000093857
Business type:
Domestic for Profit Corporation
President, Secretary:
Wendell O. Blake (President, Secretary)
Agent:
John F. Wendel

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