Provider Demographics
NPI:1154992832
Name:BLAKE FENKELL P.L.L.C.
Entity type:Organization
Organization Name:BLAKE FENKELL P.L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BLAKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FENKELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:248-660-6898
Mailing Address - Street 1:6905 ROCHESTER RD STE A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1282
Mailing Address - Country:US
Mailing Address - Phone:248-828-1100
Mailing Address - Fax:248-817-2203
Practice Address - Street 1:6905 ROCHESTER RD STE A
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1282
Practice Address - Country:US
Practice Address - Phone:248-828-1100
Practice Address - Fax:248-817-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-07-05
Last Update Date:2022-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center