Healthcare Provider Details

I. General information

NPI: 1871923292
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL BLADES
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/21/2013
Last Update Date: 01/14/2025
Certification Date: 01/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

141 WEST COMMERCIAL STREET
PORTLAND ME
04102
US

IV. Provider business mailing address

141 W COMMERCIAL ST
PORTLAND ME
04102-3905
US

V. Phone/Fax

Practice location:
  • Phone: 207-623-8411
  • Fax:
Mailing address:
  • Phone: 207-623-8411
  • Fax: 207-623-5779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: