Provider Demographics
NPI:1053589465
Name:MCDONALD, MICHAEL LEE (MD)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:LEE
Last Name:MCDONALD
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:10101 SE MAIN ST
Mailing Address - Street 2:# 2004
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2455
Mailing Address - Country:US
Mailing Address - Phone:503-257-3204
Mailing Address - Fax:503-255-7208
Practice Address - Street 1:10101 SE MAIN ST
Practice Address - Street 2:# 2004
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2455
Practice Address - Country:US
Practice Address - Phone:503-257-3204
Practice Address - Fax:503-255-7208
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-19
Last Update Date:2015-03-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00041925207YS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207YS0012XAllopathic & Osteopathic PhysiciansOtolaryngologySleep Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORA45555Medicare UPIN
OR0000WCVBQMedicare PIN