Individual
DR. TYLER D. BLAKLEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1400 N RITTER AVE, INDIANAPOLIS, IN 46219-3052
(317) 355-9370
Mailing address
6626 E 75TH ST, SUITE 500, INDIANAPOLIS, IN 46250-2890
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
01074979A
IN
207R00000X
Internal Medicine Physician
51778
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
P01678759
MEDICARE RAILROAD PTAN
IN
Enumeration date
04/02/2012
Last updated
10/14/2016
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