Provider Demographics
NPI:1891952370
Name:BLAKE, JENNIFER MARIE (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MARIE
Last Name:BLAKE
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Gender:F
Credentials:MD
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Mailing Address - Street 1:4201 SAINT ANTOINE ST
Mailing Address - Street 2:UHC 5D - MAILBOX 226 UNIVERSITY PEDIATRICIANS
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201-2153
Mailing Address - Country:US
Mailing Address - Phone:313-745-4405
Mailing Address - Fax:313-966-0665
Practice Address - Street 1:3901 BEAUBIEN ST
Practice Address - Street 2:CHILDRENS HOSPITAL OF MI 4TH FL
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201-2119
Practice Address - Country:US
Practice Address - Phone:313-745-5484
Practice Address - Fax:313-966-2423
Is Sole Proprietor?:No
Enumeration Date:2008-05-21
Last Update Date:2017-01-18
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Provider Licenses
StateLicense IDTaxonomies
MI43010907822080P0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0202XAllopathic & Osteopathic PhysiciansPediatricsPediatric Cardiology