Individual
MR. MIDIAN KRASH TENEBRAE-HICKEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 546-6377
Mailing address
6200 SE KING RD, PORTLAND, OR 97222-2891
(503) 546-6377
Taxonomy
Speciality
Code
Description
License number
State
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
05/19/2023
Last updated
05/19/2023
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