Provider Demographics
NPI:1841273364
Name:ALBERTS, MICHELLE S (MD)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:S
Last Name:ALBERTS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 22075
Mailing Address - Street 2:
Mailing Address - City:MILWAUKIE
Mailing Address - State:OR
Mailing Address - Zip Code:97269-2075
Mailing Address - Country:US
Mailing Address - Phone:503-659-4777
Mailing Address - Fax:503-652-5223
Practice Address - Street 1:1508 DIVISION ST
Practice Address - Street 2:PLAZA 2, SUITE 25
Practice Address - City:OREGON CITY
Practice Address - State:OR
Practice Address - Zip Code:97045-1582
Practice Address - Country:US
Practice Address - Phone:503-659-4988
Practice Address - Fax:503-353-1234
Is Sole Proprietor?:No
Enumeration Date:2005-11-29
Last Update Date:2012-11-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ORMD21760207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR080142070OtherRR MEDICARE
OR133953Medicaid
ORG26372Medicare UPIN
OR104824Medicare PIN