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General NPI Number Information
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NPI Number | 1134194228
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Entity Type | Individual
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Provider Name | CHARLES BLADES II CRNA
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Gender | Male
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Dates
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Enumeration Date | 02/22/2006
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Last Update Date | 04/16/2025
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Provider Practice Location Address
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Address Line | 800 W. CENTRAL RD. DEPARTMENT OF ANESTHESIA
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City | ARLINGTON HEIGHTS
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State | IL
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Zip | 60005-2349
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Country | US
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Telephone | 847-618-7140
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Fax |
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Provider Business Mailing Address
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Address Line | 900 PEELER ST
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City | KALAMAZOO
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State | MI
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Zip | 49008-2380
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Country | US
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Telephone | 269-345-8618
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Fax | 269-345-1508
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4704215663
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License Number State | MI
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 209032186
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License Number State | IL
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