Healthcare Provider Details

I. General information

NPI: 1063850576
Provider Name (Legal Business Name): PHILIP A. BLANEY M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/06/2013
Last Update Date: 09/05/2025
Certification Date: 09/05/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1877 PRAIRIE SKY LN
GREENWOOD IN
46143-6640
US

IV. Provider business mailing address

1877 PRAIRIE SKY LN
GREENWOOD IN
46143-6640
US

V. Phone/Fax

Practice location:
  • Phone: 435-668-2481
  • Fax:
Mailing address:
  • Phone: 435-668-2481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QS0010X
TaxonomySports Medicine (Family Medicine) Physician
License Number01076512A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number01076512A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: