Provider Demographics
NPI:1144422114
Name:GREENLEE, MICHAELINE MARIE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAELINE
Middle Name:MARIE
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MICHAELINE
Other - Middle Name:MARIE
Other - Last Name:FORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:2800 N VANCOUVER AVE
Mailing Address - Street 2:SUITE 165
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97227-1630
Mailing Address - Country:US
Mailing Address - Phone:503-413-2902
Mailing Address - Fax:503-413-5220
Practice Address - Street 1:2800 N VANCOUVER AVE
Practice Address - Street 2:SUITE 165
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-1630
Practice Address - Country:US
Practice Address - Phone:503-413-2902
Practice Address - Fax:503-413-5220
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD28410208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8521528Medicaid
OR023633Medicaid