Provider Demographics
NPI:1881867539
Name:DAVID E BILSTROM MD, PC
Entity Type:Organization
Organization Name:DAVID E BILSTROM MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:E
Authorized Official - Last Name:BILSTROM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:503-245-8060
Mailing Address - Street 1:9370 SW GREENBURG RD
Mailing Address - Street 2:311
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97223-5442
Mailing Address - Country:US
Mailing Address - Phone:503-245-8060
Mailing Address - Fax:503-245-8104
Practice Address - Street 1:9370 SW GREENBURG RD
Practice Address - Street 2:311
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97223-5442
Practice Address - Country:US
Practice Address - Phone:503-245-8060
Practice Address - Fax:503-245-8104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-02
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD10617174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR017343Medicaid
ORC92218Medicare UPIN