Provider Demographics
NPI:1003897026
Name:BLAKENEY, CHRISTINE A (MD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:A
Last Name:BLAKENEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:1520 RAMBLEWOOD DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EAST LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48823
Mailing Address - Country:US
Mailing Address - Phone:517-324-9400
Mailing Address - Fax:517-324-9482
Practice Address - Street 1:1520 RAMBLEWOOD DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:EAST LANSING
Practice Address - State:MI
Practice Address - Zip Code:48823
Practice Address - Country:US
Practice Address - Phone:517-324-9400
Practice Address - Fax:517-324-9482
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-08
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008336207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4167845Medicaid
MI080D410020OtherBLUE CROSS BLUE SHIELD
MI202870OtherMCLAREN HEALTH PLAN
MI0100690OtherPHYSICIANS HEALTH PLAN
MI0157800124OtherBLUE CROSS BLUE SHIELD
MI080D410020OtherCOMMUNITY BLUE
MI080D410020OtherBLUE CARE NETWORK
MI202870OtherHEALTH ADVANTAGE NETWORK
MI080D410020OtherBLUE CHOICE
MI4053286OtherAETNA
MI0157800124OtherBLUE CROSS BLUE SHIELD
MI4167845Medicaid