MEDICARE: DR. MICHAEL ROSS TANGUM 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
1	207R00000X	Internal Medicine Physician	MD21239	OR

Other Identifiers

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

General Provider Information

NPI Number	:	1497729321
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL ROSS TANGUM M.D.

Provider Business Mailing Address
First Line	:	3566 NE ALAMEDA ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97212-1808
Country	:	US
Telephone Number	:	503-282-7871
Fax Number	:

Provider Business Practice Location Address
First Line	:	1015 NW 22ND AVE
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97210-3025
Country	:	US
Telephone Number	:	503-413-7711
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/15/2006
Last Update Date	:	09/06/2011

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