Basic Information
| Provider Information | |||||||||
| NPI: | 1891789103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BLAHUNKA | ||||||||
| FirstName: | JAMES | ||||||||
| MiddleName: | J | ||||||||
| NamePrefix: | |||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 9998 CROSSPOINT BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178068260 | ||||||||
| FaxNumber: | 3178068296 | ||||||||
| Practice Location | |||||||||
| Address1: | 9998 CROSSPOINT BLVD | ||||||||
| Address2: | STE 200 | ||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462563307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3178068260 | ||||||||
| FaxNumber: | 3178068296 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/01/2005 | ||||||||
| LastUpdateDate: | 09/21/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 01047869A | IN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 300138598 | 01 | IN | RR MEDICARE PINS | OTHER | P00024088 | 01 | IN | RR MEDICARE PINS | OTHER | 00000189547 | 01 | IN | ANTHEM | OTHER | P00024186 | 01 | IN | RR MEDICARE PINS | OTHER | 200279170A | 05 | IN | MEDICAID | P00024063 | 01 | IN | RR MEDICARE PINS | OTHER | P00024093 | 01 | IN | RR MEDICARE PINS | OTHER | P00024074 | 01 | IN | RR MEDICARE PINS | OTHER | P00024075 | 01 | IN | RR MEDICARE PINS | OTHER | P00024190 | 01 | IN | RR MEDICARE PINS | OTHER | P00361003 | 01 | IN | RR MEDICARE PINS | OTHER | P00024110 | 01 | IN | RR MEDICARE PINS | OTHER | P00024187 | 01 | IN | RR MEDICARE PINS | OTHER | P00024420 | 01 | IN | RR MEDICARE PINS | OTHER | 300122034 | 01 | IN | RAILROAD MEDICARE | OTHER | P00024108 | 01 | IN | RR MEDICARE PINS | OTHER |