Provider Demographics
NPI:1740685585
Name:OSCHWALD, MICHAEL JOSEPH (PAC)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:JOSEPH
Last Name:OSCHWALD
Suffix:
Gender:M
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 99
Mailing Address - Street 2:
Mailing Address - City:WHITE SALMON
Mailing Address - State:WA
Mailing Address - Zip Code:98672-0099
Mailing Address - Country:US
Mailing Address - Phone:509-493-1101
Mailing Address - Fax:509-493-2838
Practice Address - Street 1:212 NE SKYLINE DR
Practice Address - Street 2:
Practice Address - City:WHITE SALMON
Practice Address - State:WA
Practice Address - Zip Code:98672-1948
Practice Address - Country:US
Practice Address - Phone:509-637-2810
Practice Address - Fax:509-493-2838
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2022-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA61007997363A00000X
ORPA174755363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500694501Medicaid
WA2081934Medicaid