Healthcare Provider Details

I. General information

NPI: 1467545996
Provider Name (Legal Business Name): MICHAEL PHILIP RESNICK MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/02/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SSAM JACKSON PARK RD
PORTLAND OR
97207
US

IV. Provider business mailing address

3491 NW RALEIGH ST
PORTLAND OR
97210
US

V. Phone/Fax

Practice location:
  • Phone: 503-220-8262
  • Fax: 360-737-1419
Mailing address:
  • Phone: 503-220-8262
  • Fax: 360-737-1419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084A0401X
TaxonomyAddiction Medicine (Psychiatry & Neurology) Physician
License Number09333
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: