NPI 1013629492

Blake Malcolm Ely, PAC

Practitioner Physician Assistant Ypsilanti, MI

Practice location

Address: 5301 McAuley Dr, Ypsilanti, MI 48197-1051
Phone: (248) 697-1548
Mailing address: 42868 Brookstone Dr, Novi, MI 48377-2713

Registered specialties

Physician Assistant Primary

Physician Assistants & Advanced Practice Nursing Providers Taxonomy 363A00000X Licence 5601012493 (MI)

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Registry record

NPI: 1013629492
Entity type: Individual
Sex (as registered): Male
NPI issued: 19 Dec 2022
Record last updated: 19 Jun 2024

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.