Organization
ML BLETTEL MD
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MILTON LOUIS BLETTEL M.D. (MEMBER MANAGER)
(503) 894-9464
Entity
Organization
Contact information
Practice address
5559 SW 85TH AVE, PORTLAND, OR 97225-1709
(503) 894-9464
(503) 926-8397
Mailing address
5559 SW 85TH AVE, PORTLAND, OR 97225-1709
(503) 894-9464
(503) 926-8397
Taxonomy
Speciality
Code
Description
License number
State
261QP2300X
Primary Care Clinic/Center
Primary
MD15147
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
078444
—
OR
Enumeration date
01/17/2012
Last updated
05/14/2012
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