Individual
MICHAEL T. CVITASH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
1508 DIVISION ST STE 105, OREGON CITY, OR 97045-1584
(503) 656-0836
(503) 656-9464
Mailing address
1508 DIVISION ST STE 105, OREGON CITY, OR 97045-1584
(503) 656-0836
(503) 656-9464
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA159365
OR
363AS0400X
Surgical Physician Assistant
PA159365
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100508235
—
NV
01
—
11832611
CAQH
—
01
—
P00378675
RR MEDICARE
NV
Enumeration date
03/09/2006
Last updated
08/28/2012
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