Individual
WAYLAND G BLIKKEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1305 N ELM ST, HENDERSON, KY 42420-2783
(270) 827-0353
(270) 827-4966
Mailing address
PO BOX 3276, EVANSVILLE, IN 47731-3276
(812) 473-0181
(812) 473-5822
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
01045943A
IN
207L00000X
Anesthesiology Physician
Primary
24826
KY
207LP2900X
Pain Medicine (Anesthesiology) Physician
01045943A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000065510
BLUE SHIELD
IN
05
—
200121900
—
IN
01
—
430048801
RAILROAD MEDICARE
—
05
—
64880461
—
KY
Enumeration date
06/02/2006
Last updated
12/26/2014
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