Individual
MICHAEL C WIDMER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D
Contact information
Practice address
1501 NE MEDICAL CENTER DR, BEND, OR 97701-6051
(541) 382-2811
Mailing address
PO BOX 670, BEND, OR 97709-0670
(541) 389-7741
(541) 278-8375
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
MD22936
OR
207RC0000X
Cardiovascular Disease Physician
MD22936
OR
207RI0011X
Interventional Cardiology Physician
Primary
MD22936
OR
207UN0901X
Nuclear Cardiology Physician
MD22936
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
150842
—
OR
01
—
P00083868
RAIL ROAD MEDICARE
OR
Enumeration date
02/15/2006
Last updated
03/29/2021
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