Healthcare Provider Details

I. General information

NPI: 1982137394
Provider Name (Legal Business Name): WILLIAM R BLACKBURN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: RYAN BLACKBURN MD

II. Dates (important events)

Enumeration Date: 04/04/2017
Last Update Date: 12/10/2025
Certification Date: 12/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

IV. Provider business mailing address

5500 ARMSTRONG RD
BATTLE CREEK MI
49037-7314
US

V. Phone/Fax

Practice location:
  • Phone: 269-966-5600
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number4301508277
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: