Individual
BLAKE MALCOLM ELY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5301 MCAULEY DR, YPSILANTI, MI 48197-1051
(248) 697-1548
Mailing address
42868 BROOKSTONE DR, NOVI, MI 48377-2713
(248) 697-1548
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601012493
MI
Other
Enumeration date
12/19/2022
Last updated
06/19/2024
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