Healthcare Provider Details

I. General information

NPI: 1801647029
Provider Name (Legal Business Name): ANDRZEJ P STADNIK PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2024
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6327 SE MILWAUKIE AVE
PORTLAND OR
97202-5418
US

IV. Provider business mailing address

PO BOX 22075
MILWAUKIE OR
97269-2075
US

V. Phone/Fax

Practice location:
  • Phone: 503-659-4988
  • Fax: 503-353-1297
Mailing address:
  • Phone: 503-659-4988
  • Fax: 833-428-4937

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA222598
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: