Individual
SAILAJA M BLACKMON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
11123 PARKVIEW PLAZA DR, SUITE 101, FORT WAYNE, IN 46845-1707
(260) 425-6650
(260) 425-6649
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207V00000X
Obstetrics & Gynecology Physician
Primary
01043883A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000511561
ANTHEM PROVIDER ID# - WHC
IN
01
—
000000595613
ANTHEM
IN
05
—
200045490
—
IN
05
—
200045490A
—
IN
01
—
3013241
OH MEDICAID
IN
01
—
P00831360
RAILROAD MEDICARE
IN
Enumeration date
07/18/2005
Last updated
08/01/2025
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