Organization
ELLEN MICHAELSON MD PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. ELLEN MARION MICHAELSON MD (PRESIDENT)
(503) 274-0045
Entity
Organization
Contact information
Practice address
2456 NW NORTHRUP ST, UNIT 1-A, PORTLAND, OR 97210-3253
(503) 274-0045
(503) 243-6632
Mailing address
2456 NW NORTHRUP ST, UNIT 1-A, PORTLAND, OR 97210-3253
(503) 274-0045
(503) 243-6632
Taxonomy
Speciality
Code
Description
License number
State
207RH0000X
Hematology (Internal Medicine) Physician
Primary
MD018281
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
831885000
BLUECROSS
OR
01
—
A002
TRICARE
OR
Enumeration date
07/02/2007
Last updated
07/17/2012
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