Healthcare Provider Details

I. General information

NPI: 1053589465
Provider Name (Legal Business Name): MICHAEL LEE MCDONALD M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/19/2008
Last Update Date: 03/10/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10101 SE MAIN ST # 2004
PORTLAND OR
97216-2455
US

IV. Provider business mailing address

10101 SE MAIN ST # 2004
PORTLAND OR
97216-2455
US

V. Phone/Fax

Practice location:
  • Phone: 503-257-3204
  • Fax: 503-255-7208
Mailing address:
  • Phone: 503-257-3204
  • Fax: 503-255-7208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207YS0012X
TaxonomySleep Medicine (Otolaryngology) Physician
License NumberMD00041925
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: