Individual
BLAKE EDWARD AVERILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1703 W STONES CROSSING RD STE 100, GREENWOOD, IN 46143-8558
(317) 781-1133
(317) 837-4640
Mailing address
PO BOX 781076, DETROIT, MI 48278-1076
(317) 528-4800
(317) 865-1479
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01082209A
IN
207QS0010X
Sports Medicine (Family Medicine) Physician
01082209A
IN
Other
Enumeration date
05/30/2017
Last updated
08/05/2025
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