Active NPI
Michele Marie Herzog-Dial, LMT
- Other Technician
- Milwaukie, OR
National Provider Identifier
1164847992
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Other Technician
- License
- 4576
- Practice address
- 4400 SE Risley Ave
Milwaukie, OR 97267-2954 - Phone
- (971) 998-4442
- Fax
- (503) 850-4651
- NPI assigned
- Mar 4, 2014
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Other Technician | 247200000X | 4576 | OR | Primary |
Addresses
Primary practice location
4400 SE Risley Ave
Milwaukie, OR 97267-2954
Mailing address
4400 SE Risley Ave
Milwaukie, OR 97267-2954
Phone (971) 998-4442
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4576 | OR | MD | Other Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1393891200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1393891200000",
"number": "1164847992",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4400 SE RISLEY AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972672954",
"telephone_number": "971-998-4442",
"fax_number": "503-850-4651"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4400 SE RISLEY AVE",
"city": "MILWAUKIE",
"state": "OR",
"postal_code": "972672954",
"telephone_number": "971-998-4442",
"fax_number": "503-850-4651"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HERZOG-DIAL",
"first_name": "MICHELE",
"middle_name": "MARIE",
"credential": "LMT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-03-04",
"last_updated": "2014-03-04",
"status": "A"
},
"taxonomies": [
{
"code": "247200000X",
"taxonomy_group": "",
"desc": "Technician, Other",
"state": "OR",
"license": "4576",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Milwaukie, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 4, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.