Provider Demographics
NPI:1679218523
Name:BLADES, CARLESHA ASHANTI (MD)
Entity Type:Individual
Prefix:MS
First Name:CARLESHA
Middle Name:ASHANTI
Last Name:BLADES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3730 4TH ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48201
Mailing Address - Country:US
Mailing Address - Phone:248-763-6757
Mailing Address - Fax:
Practice Address - Street 1:4201 ST. ANTOINE BOULEVARD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48201
Practice Address - Country:US
Practice Address - Phone:313-745-3000
Practice Address - Fax:313-993-8669
Is Sole Proprietor?:No
Enumeration Date:2022-05-04
Last Update Date:2022-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
MI4321049799390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program