Individual
MICHAEL C BLAKLEY JR.
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
705 RILEY HOSPITAL DR, RR 307, INDIANAPOLIS, IN 46202-5109
(317) 274-2172
(317) 278-3031
Mailing address
PO BOX 719094, CHICAGO, IL 60677-9318
(317) 777-6435
(317) 777-6644
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01060351A
IN
207RR0500X
Rheumatology Physician
01060351A
IN
208000000X
Pediatrics Physician
01060351A
IN
2080P0216X
Pediatric Rheumatology Physician
Primary
01060351A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000769478
ANTHEM PTAN
IN
01
—
000000774382
ANTHEM PTAN
IN
05
—
200903650
—
IN
01
—
P01339696
RAILROAD MEDICARE
IN
Enumeration date
11/23/2005
Last updated
02/06/2026
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