Individual
MICHAEL H WALCZYK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1130 NW 22ND AVE STE 400, PORTLAND, OR 97210-2971
(503) 413-6722
(503) 413-6563
Mailing address
PO BOX 4037, PORTLAND, OR 97208-4037
(503) 413-4048
(503) 413-2910
Taxonomy
Speciality
Code
Description
License number
State
207RN0300X
Nephrology Physician
Primary
13217
OR
207RN0300X
Nephrology Physician
23874
WA
207RN0300X
Nephrology Physician
MD19676
HI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1029586
—
WA
05
—
147116
—
OR
Enumeration date
03/14/2006
Last updated
01/14/2020
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