Provider Demographics
NPI:1083688931
Name:MIERISCH, CAY MICHAEL (MD)
Entity Type:Individual
Prefix:
First Name:CAY
Middle Name:MICHAEL
Last Name:MIERISCH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1189
Mailing Address - Street 2:
Mailing Address - City:CORVALLIS
Mailing Address - State:OR
Mailing Address - Zip Code:97339-1189
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3620 NW SAMARITAN DR STE 201
Practice Address - Street 2:
Practice Address - City:CORVALLIS
Practice Address - State:OR
Practice Address - Zip Code:97330-3785
Practice Address - Country:US
Practice Address - Phone:541-768-6300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-02-16
Last Update Date:2021-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101-237955207X00000X
VA0101237955207XS0106X
ORMD205645207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
No207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1083688931OtherINTOTAL
VA1083688931OtherCIGNA
VA1083688931OtherMEDICAID OF NORTH CAROLINA
VA1083688931Medicaid
VA1083688931OtherUMWA
VA1083688931OtherHEALTHKEEPERS
VA1083688931OtherVA PREMIER
VA1083688931OtherUNITED HEALTHCARE
VA3810010052OtherMEDICAID OF WEST VIRGINIA
VAP00239901OtherRAILROAD MEDICARE
VA1083688931OtherHEALTHKEEPERS PLUS
VA1083688931OtherSOUTHERN HEALTH/CARENET/CARELINK/COVENTRY
VA1083688931OtherVIRGINIA HEALTH NETWORK
VA371194700OtherBLACK LUNG
VA1083688931OtherHUMANA MEDICARE
VA1083688931OtherAETNA
VA1083688931OtherANTHEM
VA540506332004OtherTRICARE/CHAMPUS
VA1083688931OtherGATEWAY
VA1083688931OtherOPTIMA HEALTH PLAN
VA1083688931OtherMEDICAID OF NORTH CAROLINA
VAI13624Medicare UPIN
VA1083688931OtherGATEWAY