Provider Demographics
NPI:1851444707
Name:FROBERG, BLAKE AARON (MD)
Entity Type:Individual
Prefix:DR
First Name:BLAKE
Middle Name:AARON
Last Name:FROBERG
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 1026
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46206-1026
Mailing Address - Country:US
Mailing Address - Phone:317-274-1201
Mailing Address - Fax:317-278-9905
Practice Address - Street 1:705 RILEY HOSPITAL DR
Practice Address - Street 2:RI 1721
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5109
Practice Address - Country:US
Practice Address - Phone:317-962-8067
Practice Address - Fax:317-962-3796
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2021-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01060973A208000000X
IN010609732080T0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080T0002XAllopathic & Osteopathic PhysiciansPediatricsMedical Toxicology
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200875250Medicaid
WV3810016819Medicaid
AZ469605Medicaid