DR. MICHAEL C BLAKLEY JR. (NPI# 1184607038) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1184607038 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL C BLAKLEY JR. |
| Credential | MD |
| Practice Address |
705 Riley Hospital Dr Rr 307 Indianapolis IN 46202-5109 |
| Mailing Address |
Po Box 1026 Indianapolis IN 46206-1026 |
| Practice Telephone | 3172742172 |
| Practice Fax Number | 3172783031 |
| Mailing Telephone | 3172741201 |
| Mailing Fax Number | 3172789905 |
| Enumeration Date | 2005-11-23 |
| Last Update Date | 2014-09-19 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 207R00000X | Internal Medicine | 01060351A | IN | Allopathic & Osteopathic Physicians |
| N | 207RR0500X |
Internal Medicine Specialization: Rheumatology |
01060351A | IN | Allopathic & Osteopathic Physicians |
| N | 208000000X | Pediatrics | 01060351A | IN | Allopathic & Osteopathic Physicians |
| Y | 2080P0216X |
Pediatrics Specialization: Pediatric Rheumatology |
01060351A | IN | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IN | RAILROAD MEDICARE | P01339696 | 01 |
| IN | 200903650 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1184936775 | Michael Allen Blakley | Massage Therapist | 2550 Windy Hill Rd Se, 215, Marietta, GA 30067-8665 | 2010-07-12 |
| Street Address |
705 RILEY HOSPITAL DR RR 307 |
| City | INDIANAPOLIS |
| State | IN |
| Zip Code | 46202-5109 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821095308 | Laquia Vinson | Dentist | 705 Riley Hospital Dr, Suite 4205, Indianapolis, IN 46202-5109 | 2005-06-30 |
| 1801403928 | Morgan Lewis | Nurse Anesthetist, Certified Registered | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-09-24 |
| 1063028009 | Maham Fatima | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-09-16 |
| 1871105205 | Rosemary Bland | Nurse Practitioner | 705 Riley Hospital Dr, Ri 1134, Indianapolis, IN 46202-5109 | 2020-08-18 |
| 1720699226 | Nancy Marie Dalton | Physician Assistant | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-08-10 |
| 1205446325 | Nadine Al Homsi | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-08-04 |
| 1477162808 | Julia Lamotte | Psychologist | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-31 |
| 1154930626 | Anna Himes | Nurse Practitioner | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| 1750990230 | Victoria H Klee | Genetic Counselor, MS | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| 1134738677 | Jenna Pogorzelski | Dietitian, Registered | 705 Riley Hospital Dr, Indianapolis, IN 46202-5109 | 2020-07-30 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790386886 | Sara Brooke Horn | Registered Nurse | 1801 N Senate Ave Ste 3300, Indianapolis, IN 46202 | 2020-11-04 |
| 1013521905 | Zachary Camden Grimes | Registered Nurse | 720 Eskenazi Avenute, Indianapolis, IN 46202 | 2020-09-08 |
| 1790314045 | Scott C Mitchell II | Student in an Organized Health Care Education/Training Program | Indiana University School of Medicine Dept of Neurosurg, 355 W. 16th St, Gh 5100, Indianapolis, IN 46202 | 2020-04-07 |
| 1053940676 | James Patrick Kelly Iv | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Dr., Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1124657697 | Betsy Wilson Stevens | Student in an Organized Health Care Education/Training Program | 705 Riley Hospital Drive, Ri-5837, Indianapolis, IN 46202 | 2020-04-06 |
| 1093340580 | Brian T Edmonds | Social Worker | Sandra Eskenazi Mental Health Center, 1700 N Illinois St, Indianapolis, IN 46202 | 2020-03-05 |
| 1326683210 | Lindsay Nicole Rich | Nurse Practitioner | 1800 N Senate Ave, Indianapolis, IN 46202 | 2019-11-14 |
| 1427693670 | Ronald Mcdonald House Charities of Central Indiana | Voluntary or Charitable | 435 Limestone Street, Indianaplois, IN 46202 | 2019-11-12 |
| 1790344760 | Kirsten Denise Leaberry | Student in an Organized Health Care Education/Training Program | Iu Health Neuroscience Center, Goodman Hall, 355 West 16th Street, Indianapolis, IN 46202 | 2019-06-12 |
| 1679138093 | Chris Olson Jr. | Student in an Organized Health Care Education/Training Program | 1701 N. Senate Blvd, Ag012, Indianapolis, IN 46202 | 2019-05-02 |
| Find all providers in zip 46202 | ||||
| Taxonomy Code | 2080P0216X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pediatrics |
| Specialization | Pediatric Rheumatology |
| A pediatrician who treats diseases of joints, muscle, bones and tendons. A pediatric rheumatologist diagnoses and treats arthritis, back pain, muscle strains, common athletic injuries and "collagen" diseases. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition added, source added] Additional Resources: American Board of Pediatrics, 2007. http://www.abp.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Pediatrics. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1376951012 | Martha M. Rodriguez | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2014-07-25 |
| 1699059188 | Ellen J. L. Go | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2011-10-04 |
| 1063704112 | Brandi Eastman Stevens | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2011-05-09 |
| 1326337304 | Melissa Susan Oliver | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2011-03-30 |
| 1831383223 | Eric P Hanson | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2007-08-29 |
| 1639380769 | Stacey Elaine Tarvin | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2007-05-24 |
| 1780793869 | Susan H Ballinger | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2006-08-30 |
| 1306815402 | Kathleen M O'neil | Pediatrics | 705 Riley Hospital Dr, Rr 307, Indianapolis, IN 46202-5109 | 2006-03-14 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023203239 | St. Vincent Hospital and Health Care Center, Inc. | Pediatrics | 2200 Randallia Dr, Fort Wayne, IN 46805-4638 | 2007-09-11 |
| City | INDIANAPOLIS |
| Zip Code | 46202 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.