Individual
MR. MICHAEL JAMES MELLICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
412 SW 12TH AVE, PORTLAND, OR 97205-2329
(503) 228-7134
(503) 445-0749
Mailing address
232 NW 6TH AVE, PORTLAND, OR 97209-3609
(503) 294-1681
(503) 241-7419
Taxonomy
Speciality
Code
Description
License number
State
372600000X
Adult Companion
Primary
—
—
Other
Enumeration date
01/25/2007
Last updated
02/04/2009
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