Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | 0101258386 | VA |
N | 207Q00000X | Family Doctor | D0040152 | MD |
N | 207Q00000X | Family Doctor | MD180886 | OR |
Y | 207QH0002X | Family Doctor - Hospice and Palliative Medicine | MD180886 | OR |
NPI | 1346268158 |
---|---|
Provider Name | Micki A Kantrowitz |
First Address | Portland, OR 97213-4759 |
Second Address | Portland, OR 97213-4759 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2006 |
Last Update Date | 20/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B86180 | (02) |