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General NPI Number Information
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NPI Number | 1831570043
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Entity Type | Individual
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Provider Name | BLAKE MILLAR FECHTEL M.D.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2015
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Last Update Date | 04/23/2024
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Provider Practice Location Address
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Address Line | 800 ZORN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 502-287-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 800 ZORN AVE
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City | LOUISVILLE
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State | KY
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Zip | 40206-1433
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Country | US
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Telephone | 502-287-4000
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Fax |
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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 | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number | 54241
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 54241
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 54241
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License Number State | KY
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