Healthcare Provider Details

I. General information

NPI: 1154992832
Provider Name (Legal Business Name): BLAKE FENKELL P.L.L.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2021
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32100 TELEGRAPH RD # MI48025
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: 248-828-1100
  • 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 Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. BLAKE R FENKELL
Title or Position: OWNER/DOCTOR
Credential:
Phone: 248-828-1100