Healthcare Provider Details

I. General information

NPI: 1760440127
Provider Name (Legal Business Name): BLAIR MACPHAIL MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1855 S MAIN ST STE A
GOSHEN IN
46526-4852
US

IV. Provider business mailing address

1855 S MAIN ST STE A
GOSHEN IN
46526-4852
US

V. Phone/Fax

Practice location:
  • Phone: 574-533-7476
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0000X
TaxonomyCardiovascular Disease Physician
License Number01039182A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: