MEDICARE: MICHAEL C BLAKLEY JR. MD

Medicare Provider Information

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208000000X	Pediatrics Physician	01060351A	IN
2	207R00000X	Internal Medicine Physician	01060351A	IN
3	207RR0500X	Rheumatology Physician	01060351A	IN
4	2080P0216X	Pediatric Rheumatology Physician	01060351A	IN

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	P01339696	OTHER	IN	RAILROAD MEDICARE

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	000000774382	OTHER	IN	ANTHEM PTAN
3	000000769478	OTHER	IN	ANTHEM PTAN

NPI Number	:	1184607038
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL C BLAKLEY JR. MD

Provider Business Mailing Address
First Line	:	PO BOX 719094
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60677-9318
Country	:	US
Telephone Number	:	317-777-6435
Fax Number	:	317-777-6644

Provider Business Practice Location Address
First Line	:	705 RILEY HOSPITAL DR
Second Line	:	RR 307
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46202-5109
Country	:	US
Telephone Number	:	317-274-2172
Fax Number	:	317-278-3031

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

Provider Enumeration Date	:	11/23/2005
Last Update Date	:	02/06/2026

705 RILEY HOSPITAL DR , RR 307
INDIANAPOLIS, IN
46202-5109

Practice Phone: 317-274-2172
Practice Fax: 317-274-3031