MICHAEL VAN WYNGARDEN

PORTLAND, OR
NPI1790379451
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy363AM0700X Physician Assistant, Medical
(Licence: OR  PA223530)
Additional Taxonomies363A00000X Physician Assistant
(Licence: CO  PA.0007421)
Enumeration Date2021-02-23
Last Update Date2025-03-11
Business Address
MICHAEL VAN WYNGARDEN Physician Assistant
3303 S BOND AVE
PORTLAND, OR 97239-4501
Phone number: 503-494-5058
Mailing Address
MICHAEL VAN WYNGARDEN Physician Assistant
1400 SW 5TH AVE STE 500
PORTLAND, OR 97201-5537
Phone number: 866-617-6855