Individual
MISCHA B RONICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4920 N INTERSTATE AVE, PORTLAND, OR 97217-3653
(503) 215-3300
Mailing address
PO BOX 3158, PORTLAND, OR 97208-3158
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
MD173867
OR
390200000X
Student in an Organized Health Care Education/Training Program
57563
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500691506
—
OR
Enumeration date
05/16/2011
Last updated
03/24/2021
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