Individual
CAY MICHAEL MIERISCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3620 NW SAMARITAN DR STE 201, CORVALLIS, OR 97330-3785
(541) 768-6300
Mailing address
PO BOX 1189, CORVALLIS, OR 97339-1189
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
0101-237955
VA
207X00000X
Orthopaedic Surgery Physician
Primary
MD205645
OR
207XS0106X
Orthopaedic Hand Surgery Physician
0101237955
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1083688931
INTOTAL
VA
05
—
1083688931
—
VA
01
—
371194700
BLACK LUNG
VA
01
—
3810010052
MEDICAID OF WEST VIRGINIA
VA
01
—
540506332004
TRICARE/CHAMPUS
VA
01
—
P00239901
RAILROAD MEDICARE
VA
Enumeration date
02/16/2006
Last updated
08/13/2021
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