Provider Demographics
NPI:1477162360
Name:MK ORTHO LLC
Entity Type:Organization
Organization Name:MK ORTHO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUNINE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:817-966-4689
Mailing Address - Street 1:2351 NW WESTOVER RD UNIT 706
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97210-3783
Mailing Address - Country:US
Mailing Address - Phone:817-966-4689
Mailing Address - Fax:
Practice Address - Street 1:6485 SW BORLAND RD STE A
Practice Address - Street 2:
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-692-5483
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-27
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty