Healthcare Provider Details

I. General information

NPI: 1124236021
Provider Name (Legal Business Name): JUHA PEKKA RASANEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

18132 WESTVIEW RD
LAKE OSWEGO OR
97034-7346
US

V. Phone/Fax

Practice location:
  • Phone: 503-494-4200
  • Fax: 503-494-4473
Mailing address:
  • Phone: 503-494-2101
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberLL16607
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier807594900
Identifier TypeMEDICAID
Identifier StateID
Identifier Issuer
# 2
Identifier247329
Identifier TypeMEDICAID
Identifier StateOR
Identifier Issuer
# 3
Identifier8466294
Identifier TypeMEDICAID
Identifier StateWA
Identifier Issuer
# 4
Identifier93125743797239A739
Identifier TypeOTHER
Identifier StateOR
Identifier IssuerTRIWEST

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: