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NPI Code Detail

MEDICARE: DR. MICHAEL A WADDICK M.D.

MEDICARE: DR. MICHAEL A WADDICK 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
1207Q00000XFamily Medicine PhysicianMD00038966WA
2207Q00000XFamily Medicine PhysicianMD27159OR

Other Identifiers

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

General Provider Information

NPI Number : 1467468132
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. MICHAEL A WADDICK M.D.
Provider Business Mailing Address
First Line : PO BOX 3158
Second Line :
City : PORTLAND
State : OR
Zip : 97208-3158
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4104 SE 82ND AVE
Second Line : SUITE 250
City : PORTLAND
State : OR
Zip : 97266-2954
Country : US
Telephone Number : 503-215-9850
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/01/2006
Last Update Date : 03/25/2021

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Directions to “ DR. MICHAEL A WADDICK M.D.” Practice Location

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