Individual
LAURA ELIZABETH BLACKFORD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2349 LAKE AVE, SUITE 100, PLYMOUTH, IN 46563-7835
(574) 948-5100
(574) 948-5499
Mailing address
5215 HOLY CROSS PKWY, MISHAWAKA, IN 46545-1469
(574) 335-8700
(574) 335-0760
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
008-T1
WY
207Q00000X
Family Medicine Physician
Primary
01074430
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000896281
BCBS
IN
05
—
201243260
—
IN
01
—
P01504489
RR MEDICARE
IN
Enumeration date
08/16/2011
Last updated
01/13/2026
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