Individual
DR. INGMAR KLASEEN PROKOP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1200 NW 23RD AVE, PORTLAND, OR 97210-2906
(503) 413-7074
(503) 413-6892
Mailing address
2900 VALENTINE LN, REDDING, CA 96001-3643
(530) 524-3547
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
MD61055398
WA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/26/2017
Last updated
08/11/2021
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