Healthcare Provider Details

I. General information

NPI: 1487605739
Provider Name (Legal Business Name): MARK G. WILTRAKIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 11/23/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

527 SE BASELINE ST SUITE E
HILLSBORO OR
97123-4149
US

IV. Provider business mailing address

527 SE BASELINE ST SUITE E
HILLSBORO OR
97123-4149
US

V. Phone/Fax

Practice location:
  • Phone: 503-648-9591
  • Fax: 503-648-3872
Mailing address:
  • Phone: 503-648-9591
  • Fax: 503-648-3872

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD10754
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: