Healthcare Provider Details

I. General information

NPI: 1033596069
Provider Name (Legal Business Name): BLAKE FENKELL D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2015
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32100 TELEGRAPH RD STE 111
BINGHAM FARMS MI
48025-2452
US

IV. Provider business mailing address

32100 TELEGRAPH RD STE 111
BINGHAM FARMS MI
48025-2452
US

V. Phone/Fax

Practice location:
  • Phone: 248-803-0110
  • Fax: 248-817-2203
Mailing address:
  • Phone: 248-803-0110
  • Fax: 248-817-2203

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101026388
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number5101021549
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: