ML BLETTEL MD NPI 1083985428

NPI Information

ML BLETTEL MD is a primary care clinic center in Portland, OR. ML BLETTEL MD NPI is 1083985428. The provider is registered as an organization entity type.

The provider's business location address is:

5559 SW 85TH AVE
PORTLAND, OR
ZIP 97225-709
Phone: (503) 894-9464
Fax: (503) 926-8397

The provider's authorized official is Milton Louis Blettel .
The authorized official title is Member Manager and has the following contact phone number (503) 894-9464.

The enumeration date for this NPI number is 1/17/2012 and was last updated on 5/14/2012.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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