Healthcare Provider Details

I. General information

NPI: 1821577537
Provider Name (Legal Business Name): BLAKE MARTIN ANDREWS CNIM
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2018
Last Update Date: 03/19/2026
Certification Date: 03/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3410 BELLE CHASE WAY STE 600
LANSING MI
48911-4274
US

IV. Provider business mailing address

50 ROSE PL
NEW HYDE PARK NY
11040-5311
US

V. Phone/Fax

Practice location:
  • Phone: 888-279-6336
  • Fax:
Mailing address:
  • Phone: 888-279-6336
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246ZE0600X
TaxonomyElectroneurodiagnostic Specialist/Technologist
License Number4119
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: