Provider Demographics
NPI:1982694568
Name:BLECHL, JAMES F (MD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:F
Last Name:BLECHL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4440 NORTH PORTAGE
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46628-9570
Mailing Address - Country:US
Mailing Address - Phone:574-204-6200
Mailing Address - Fax:574-288-1426
Practice Address - Street 1:4440 NORTH PORTAGE
Practice Address - Street 2:
Practice Address - City:SOUTH BEND
Practice Address - State:IN
Practice Address - Zip Code:46628-9570
Practice Address - Country:US
Practice Address - Phone:574-204-6200
Practice Address - Fax:574-288-1426
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2016-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01033920A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100090110Medicaid
IN100090110Medicaid
IN146470YYMedicare ID - Type Unspecified