Individual
MALLIK N TELLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
10123 SE MARKET ST, PORTLAND, OR 97216-2599
(503) 257-2500
Mailing address
10123 SE MARKET ST, PORTLAND, OR 97216-2532
(503) 257-2500
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
MD155385
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500637769
—
OR
Enumeration date
08/30/2006
Last updated
10/02/2024
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