Healthcare Provider Details

I. General information

NPI: 1003897026
Provider Name (Legal Business Name): CHRISTINE A BLAKENEY MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/08/2005
Last Update Date: 02/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 RAMBLEWOOD DR. SUITE 100
EAST LANSING MI
48823
US

IV. Provider business mailing address

1520 RAMBLEWOOD DR. SUITE 100
EAST LANSING MI
48823
US

V. Phone/Fax

Practice location:
  • Phone: 517-324-9400
  • Fax: 517-324-9482
Mailing address:
  • Phone: 517-324-9400
  • Fax: 517-324-9482

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number5101008336
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: