Individual
ELLEN MARION MICHAELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
2222 NW LOVEJOY ST STE 510, PORTLAND, OR 97210-5103
(503) 274-0045
Mailing address
2222 NW LOVEJOY ST STE 510, PORTLAND, OR 97210-5103
(503) 274-0045
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD18281
OR
207RH0000X
Hematology (Internal Medicine) Physician
MD018281
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
057039
OMAP
OR
01
—
804692001
BLUE CROSS
OR
01
—
A002
TRICARE
OR
Enumeration date
07/08/2006
Last updated
08/09/2021
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