MEDICARE: DAVID MICHAEL BLACKWELL II MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	01047203	IN
2	207Q00000X	Family Medicine Physician	01047203A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1102455200	OTHER	IN	ANTHEM PTAN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104903111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAVID MICHAEL BLACKWELL II MD

Provider Business Mailing Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-644-3461
Fax Number	:	317-602-2654

Provider Business Practice Location Address
First Line	:	907 N EAST ST
Second Line	:
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-3425
Country	:	US
Telephone Number	:	317-644-3461
Fax Number	:	317-602-2654

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	05/15/2025

Similar Medicare Providers

1356330435 — STEPHANIE BRYANT-LIPP NPC
Practice Location Address:

907 N EAST ST
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-429-0120
Practice Fax:

1073866687 — CHATHAM CARE PC
Practice Location Address:

907 N EAST ST
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-644-3461
Practice Fax: 317-602-2654

1043623069 — DR. JUAN CARLOS VENIS MD, MPH, FAAFP
Practice Location Address:

907 N EAST ST
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-676-6498
Practice Fax: 317-932-9404

1215589494 — KELSEY HUG
Practice Location Address:

907 N EAST ST STE 109
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-851-0512
Practice Fax:

1962375568 — KMHUG LLC
Practice Location Address:

907 N EAST ST STE 109
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-851-0512
Practice Fax:

1487520854 — STEPHEN D MOISOFF LCSW
Practice Location Address:

907 N EAST ST
INDIANAPOLIS, IN
46202-3425

Practice Phone: 317-850-3873
Practice Fax:

Directions to “ DAVID MICHAEL BLACKWELL II MD” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.