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NPI Code Detail

MEDICARE: MR. DOUGLAS ANTHONY BLAKELY CAA

MEDICARE: MR. DOUGLAS ANTHONY BLAKELY CAA
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
1367H00000XAnesthesiologist AssistantAA2000013DC
2367H00000XAnesthesiologist Assistant75000252AIN
3367H00000XAnesthesiologist AssistantAA942FL

General Provider Information

NPI Number : 1952994071
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. DOUGLAS ANTHONY BLAKELY CAA
Provider Business Mailing Address
First Line : 250 N SHADELAND AVE
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46219-4959
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1701 N SENATE BLVD
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46202-1239
Country : US
Telephone Number : 317-962-8880
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2021
Last Update Date : 06/24/2026

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Directions to “ MR. DOUGLAS ANTHONY BLAKELY CAA” Practice Location

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