Provider Demographics
NPI:1811608490
Name:PTAK, MALGORZATA (ND)
Entity type:Individual
Prefix:DR
First Name:MALGORZATA
Middle Name:
Last Name:PTAK
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:MARGARET
Other - Middle Name:
Other - Last Name:PTAK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:ND
Mailing Address - Street 1:8503 SE 57TH AVE UNIT B
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-0893
Mailing Address - Country:US
Mailing Address - Phone:917-399-7063
Mailing Address - Fax:
Practice Address - Street 1:2348 NW LOVEJOY ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-3022
Practice Address - Country:US
Practice Address - Phone:917-399-7063
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-06
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC211757171100000X
OR4485175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
No171100000XOther Service ProvidersAcupuncturist