Provider Demographics
NPI:1033596069
Name:FENKELL, BLAKE (DO)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:
Last Name:FENKELL
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6905 ROCHESTER RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48085-1282
Mailing Address - Country:US
Mailing Address - Phone:248-828-1100
Mailing Address - Fax:248-498-7594
Practice Address - Street 1:6905 ROCHESTER RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48085-1282
Practice Address - Country:US
Practice Address - Phone:248-828-1100
Practice Address - Fax:248-498-7594
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-28
Last Update Date:2021-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021549207X00000X
MI5101026388207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery