Provider Demographics
NPI:1083020085
Name:DONAWA, MICHAEL ANDREW (LMT)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:ANDREW
Last Name:DONAWA
Suffix:
Gender:M
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1158 HIGH ST
Mailing Address - Street 2:SUITE 203
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3688
Mailing Address - Country:US
Mailing Address - Phone:541-953-2963
Mailing Address - Fax:
Practice Address - Street 1:1158 HIGH ST
Practice Address - Street 2:SUITE 203
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3688
Practice Address - Country:US
Practice Address - Phone:541-953-2963
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-10
Last Update Date:2014-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16194174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist