MEDICARE: CASSANDRA TOMCZAK, DPM PC

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	213E00000X	Podiatrist	DP164497	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	:	1891225181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CASSANDRA TOMCZAK, DPM PC

Provider Business Mailing Address
First Line	:	501 N GRAHAM ST STE 250
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1651
Country	:	US
Telephone Number	:	503-249-0719
Fax Number	:	503-249-0749

Provider Business Practice Location Address
First Line	:	501 N GRAHAM ST STE 250
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97227-1651
Country	:	US
Telephone Number	:	503-249-0719
Fax Number	:	503-249-0749

Authorized Official
Title or Position	:	MANAGER
Name	:	ANDREA WOLFE
Credential	:
Telephone Number	:	503-249-0719

Provider Enumeration Date	:	06/19/2017
Last Update Date	:	07/21/2022

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