Provider Demographics
NPI:1760440127
Name:MACPHAIL, BLAIR (MD)
Entity Type:Individual
Prefix:
First Name:BLAIR
Middle Name:
Last Name:MACPHAIL
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 1:1855 S MAIN ST
Mailing Address - Street 2:STE A
Mailing Address - City:GOSHEN
Mailing Address - State:IN
Mailing Address - Zip Code:46526-4852
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1855 S MAIN ST
Practice Address - Street 2:STE A
Practice Address - City:GOSHEN
Practice Address - State:IN
Practice Address - Zip Code:46526-4852
Practice Address - Country:US
Practice Address - Phone:574-533-7476
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01039182A207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100101820Medicaid
INP01678724OtherRR PTAN
IN100101820Medicaid
INM400061243Medicare PIN
ININ1663051Medicare PIN
E46744Medicare UPIN
IN218650CMedicare PIN
IN266180677Medicare PIN