Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | BB4745785 | MO |
NPI | 1013127075 |
---|---|
Provider Name | Dr. Michael David Straiko |
First Address | Portland, OR 97210 |
Second Address | Portland, OR 97210 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/05/2007 |
Last Update Date | 08/12/2015 |