Provider Demographics
NPI:1417111758
Name:MARTI, BLAKE WILLIAM (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:WILLIAM
Last Name:MARTI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6005-DEPT 196
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-6005
Mailing Address - Country:US
Mailing Address - Phone:866-282-7905
Mailing Address - Fax:800-731-0751
Practice Address - Street 1:8040 CLEARVISTA PKWY
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-5630
Practice Address - Country:US
Practice Address - Phone:317-621-2000
Practice Address - Fax:800-731-0751
Is Sole Proprietor?:No
Enumeration Date:2008-07-16
Last Update Date:2018-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01067802A207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200986610Medicaid
IN200986610Medicaid