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NPI Code Detail

MEDICARE: DR. ANGELA KALISIAK M.D.

MEDICARE: DR. ANGELA KALISIAK M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207RH0003XHematology & Oncology PhysicianMD17578OR
2207RH0002XHospice and Palliative Medicine (Internal Medicine) PhysicianMD17578OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1386647147
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANGELA KALISIAK M.D.
Provider Business Mailing Address
First Line : 265 N BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1800
Country : US
Telephone Number : 503-280-1223
Fax Number : 503-528-5252
Provider Business Practice Location Address
First Line : 265 N BROADWAY ST
Second Line :
City : PORTLAND
State : OR
Zip : 97227-1800
Country : US
Telephone Number : 503-280-1223
Fax Number : 503-528-5252
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2005
Last Update Date : 02/23/2011

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