Provider Demographics
NPI:1134194228
Name:BLADES, CHARLES II (CRNA)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:
Last Name:BLADES
Suffix:II
Gender:
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:900 PEELER ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49008-2380
Mailing Address - Country:US
Mailing Address - Phone:269-345-8618
Mailing Address - Fax:269-345-1508
Practice Address - Street 1:800 W. CENTRAL RD. DEPARTMENT OF ANESTHESIA
Practice Address - Street 2:
Practice Address - City:ARLINGTON HEIGHTS
Practice Address - State:IL
Practice Address - Zip Code:60005-2349
Practice Address - Country:US
Practice Address - Phone:847-618-7140
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-22
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4704215663367500000X
IL209032186367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4870428Medicaid
MI4521060Medicaid
MI4521060Medicaid
MIC96074101Medicare ID - Type UnspecifiedKAPC MEDICARE
MIP00362274Medicare ID - Type UnspecifiedHAPLC RAILROAD