Individual
KYLE MATTHEW BALTRUSCH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
1200 NW NAITO PKWY STE 310, PORTLAND, OR 97209-2829
(503) 292-9200
(503) 292-9205
Mailing address
1200 NW NAITO PKWY STE 310, PORTLAND, OR 97209-2829
(503) 292-9200
(503) 292-9205
Taxonomy
Speciality
Code
Description
License number
State
2086S0122X
Plastic and Reconstructive Surgery Physician
Primary
MD205639
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
500688755
—
OR
Enumeration date
06/25/2013
Last updated
07/19/2021
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