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DAVID MICHAEL BLACKWELL II

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
MD

Contact information

Practice address
907 N EAST ST, INDIANAPOLIS, IN 46202-3425
(317) 644-3461
(317) 602-2654
Mailing address
907 N EAST ST, INDIANAPOLIS, IN 46202-3425
(317) 644-3461
(317) 602-2654

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
01047203
IN
207Q00000X
Family Medicine Physician
Primary
01047203A
IN

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
1102455200
ANTHEM PTAN
IN
05
300087633
IN
Enumeration date
11/01/2006
Last updated
05/15/2025
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