MEDICARE: DR. JAMES F BLECHL 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	01033920A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982694568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAMES F BLECHL MD

Provider Business Mailing Address
First Line	:	4440 NORTH PORTAGE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-9570
Country	:	US
Telephone Number	:	574-204-6200
Fax Number	:	574-288-1426

Provider Business Practice Location Address
First Line	:	4440 NORTH PORTAGE
Second Line	:
City	:	SOUTH BEND
State	:	IN
Zip	:	46628-9570
Country	:	US
Telephone Number	:	574-204-6200
Fax Number	:	574-288-1426

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

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	08/02/2016

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