Individual
BLAINE Y TAKESUE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
5550 S EAST ST, STE I, INDIANAPOLIS, IN 46227-1991
(317) 780-4080
(317) 780-4088
Mailing address
250 N SHADELAND AVE, STE 130, INDIANAPOLIS, IN 46219-4959
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
01040029A
IN
207R00000X
Internal Medicine Physician
Primary
01040029A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100103460
—
IN
05
—
100342970
—
IN
Enumeration date
08/04/2006
Last updated
10/01/2013
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