Michael Lewis Blakesley, MD

Primary specialty

Emergency Medicine PhysicianTaxonomy code 207P00000X

License

01028547A Issued in IN

Practice address

615 N Michigan St
South Bend, IN 46601-1033

Phone

(574) 647-7459

Fax

(574) 647-3658

NPI assigned

Oct 17, 2006

Sex

Male

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Memorial Health System, Inc.

  • Physical Therapist
  • La Porte, IN
  • NPI 1013133487
  NPD (past)

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Jul 8, 2007.

{
    "created_epoch": "1161043200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1275614570",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "328 N MICHIGAN ST",
            "address_2": "SUITE 200",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011244",
            "telephone_number": "574-647-1842",
            "fax_number": "574-647-1825"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "615 N MICHIGAN ST",
            "city": "SOUTH BEND",
            "state": "IN",
            "postal_code": "466011033",
            "telephone_number": "574-647-7459",
            "fax_number": "574-647-3658"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BLAKESLEY",
        "first_name": "MICHAEL",
        "middle_name": "LEWIS",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-10-17",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207P00000X",
            "taxonomy_group": "",
            "desc": "Emergency Medicine",
            "state": "IN",
            "license": "01028547A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM PIN (ER)",
            "identifier": "000000080467",
            "state": "IN"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1653001",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Freda Ann Black, NURSE PRACTITIONER
• Heather Blackford, MA, LMHC
• Alisha Blackwell
• Randal D Bladel, M.D.
• Kecia Marie Blakely, MSPSY, LMHC
• Carrie Blankenmyer
• James F Blechl, MD
• Blessed Hands Home Care Agency LLC
• Blessing Hearts Home Care LLC
• Janelle Ruth Blickensderfer, D.O.

• All providers in South Bend, IN
• Emergency Medicine Physician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.