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General NPI Number Information
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NPI Number | 1033596069
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Entity Type | Individual
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Provider Name | BLAKE FENKELL D.O.
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Gender | Male
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Dates
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Enumeration Date | 04/28/2015
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Last Update Date | 11/12/2021
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Provider Practice Location Address
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Address Line | 6905 ROCHESTER RD
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City | TROY
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State | MI
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Zip | 48085-1282
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Country | US
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Telephone | 248-828-1100
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Fax | 248-498-7594
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Provider Business Mailing Address
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Address Line | 6905 ROCHESTER RD
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City | TROY
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State | MI
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Zip | 48085-1282
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Country | US
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Telephone | 248-828-1100
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Fax | 248-498-7594
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101021549
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 207X00000X
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Taxonomy Name | Orthopaedic Surgery Physician
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License Number | 5101026388
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License Number State | MI
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