Blakesley, Michael Lewis

Blakesley, Michael Lewis is an individual health care provider with primary practice located at 615 N Michigan St , South Bend IN 46601-1033. He recently has only one registered license in Allopathic & Osteopathic Physicians / Emergency Medicine, which is considered as his primary health care specialty. Blakesley, Michael Lewis can be contacted via phone (574) 647-7459.

Contact Information

Primary practice address
615 N Michigan St South Bend IN 46601-1033
Phone: (574) 647-7459
Fax: (574) 647-3658
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Emergency Medicine 207P00000X 01028547A Indiana

Profile Details

NPI number 1275614570
LBN Legal business name Blakesley, Michael Lewis
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Oct 17th, 2006
Last updated Jul 8th, 2007 - about 19 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1275614570 NPPES
Indiana Other 000000080467 ANTHEM PIN (ER)
Indiana MEDICAID 1653001 ANTHEM PIN (ER)

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