Provider Demographics
NPI:1427410117
Name:GARDNER, MICHAEL WINSLOW (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WINSLOW
Last Name:GARDNER
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 1:10000 SE MAIN ST STE 60
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2474
Mailing Address - Country:US
Mailing Address - Phone:503-257-0959
Mailing Address - Fax:
Practice Address - Street 1:10000 SE MAIN ST STE 60
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97216-2474
Practice Address - Country:US
Practice Address - Phone:503-257-0959
Practice Address - Fax:503-256-7757
Is Sole Proprietor?:No
Enumeration Date:2016-03-22
Last Update Date:2022-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD209315207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease