Provider Demographics
NPI:1629138409
Name:PFISTER, MICHAEL ELI (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ELI
Last Name:PFISTER
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 1:25030 SW PARKWAY AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-9816
Mailing Address - Country:US
Mailing Address - Phone:503-612-0498
Mailing Address - Fax:503-459-0521
Practice Address - Street 1:25030 SW PARKWAY AVE STE 200
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-9816
Practice Address - Country:US
Practice Address - Phone:503-612-0498
Practice Address - Fax:503-459-0521
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2020-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD203962085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR134803Medicaid
G88559Medicare UPIN
OR134803Medicaid