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1134194228

NPI Code Detail

MEDICARE: CHARLES BLADES II CRNA

MEDICARE: CHARLES BLADES II CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	367500000X	Certified Registered Nurse Anesthetist	209032186	IL
2	367500000X	Certified Registered Nurse Anesthetist	4704215663	MI
3	367500000X	Certified Registered Nurse Anesthetist	APRN11021788	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134194228
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES BLADES II CRNA

Provider Business Mailing Address
First Line	:	7449 ROLLING MEADOWS DR
Second Line	:
City	:	KALAMAZOO
State	:	MI
Zip	:	49009-7061
Country	:	US
Telephone Number	:	269-303-0557
Fax Number	:

Provider Business Practice Location Address
First Line	:	800 W. CENTRAL RD. DEPARTMENT OF ANESTHESIA
Second Line	:
City	:	ARLINGTON HEIGHTS
State	:	IL
Zip	:	60005-2349
Country	:	US
Telephone Number	:	847-618-7140
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/22/2006
Last Update Date	:	01/12/2026

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Directions to “ CHARLES BLADES II CRNA” Practice Location

Language	Start Address	Practice Location

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