Provider Demographics
NPI:1821085390
Name:MURAKAMI, CAROL SUMI (MD)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:SUMI
Last Name:MURAKAMI
Suffix:
Gender:F
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 112
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97216-2441
Mailing Address - Country:US
Mailing Address - Phone:503-255-3054
Mailing Address - Fax:
Practice Address - Street 1:104 E OLIVE AVE STE 100
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-5255
Practice Address - Country:US
Practice Address - Phone:424-338-0225
Practice Address - Fax:209-759-2672
Is Sole Proprietor?:No
Enumeration Date:2005-09-30
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3166207RG0100X
WAMD00025512207RG0100X
ORCP204540207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA100012670OtherRR MEDICARE
WAAB11165Medicare ID - Type Unspecified
WAAB11165Medicare ID - Type Unspecified
WA8180671Medicaid
WA100012670OtherRR MEDICARE