Individual
JONATHAN WILLIAM BAZELEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1701 N SENATE BLVD, INDIANAPOLIS, IN 46202-1239
(888) 484-3258
Mailing address
250 N SHADELAND AVE, INDIANAPOLIS, IN 46219-4959
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
4301089565
MI
207RN0300X
Nephrology Physician
Primary
01070207A
IN
207RN0300X
Nephrology Physician
4301089565
MI
390200000X
Student in an Organized Health Care Education/Training Program
4301089565
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000732188
ANTHEM
IN
05
—
201032900
—
IN
01
—
P01076920
RAILROAD MEDICARE
IN
Enumeration date
07/13/2007
Last updated
03/06/2025
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