Individual
MARCO JAN MADIAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
LMT
Contact information
Practice address
2442 SE 101ST AVE, STE 206, PORTLAND, OR 97216-3060
(503) 816-4477
Mailing address
PO BOX 12069, PORTLAND, OR 97212-0069
(503) 816-4477
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
15569
OR
Other
Enumeration date
01/19/2011
Last updated
01/19/2011
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