NPIMap

Individual provider Active NPI

Manohar Mulki Punja, MD

  • Cardiovascular Disease Physician
  • Gresham, OR
National Provider Identifier
1245222512
Registry record updated Jul 13, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Cardiovascular Disease PhysicianTaxonomy code 207RC0000X
License
MD08438 Issued in OR
Practice address
24900 SE Stark St
Suite 103
Gresham, OR 97030-3355
Phone
(503) 665-4278
Fax
(503) 665-7766
NPI assigned
Aug 22, 2005
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 13, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Cardiovascular Disease Physician 207RC0000X MD08438 OR Primary

Addresses

Primary practice location

24900 SE Stark St
Suite 103
Gresham, OR 97030-3355

Mailing address

975 SE Sandy Blvd
Suite 200
Portland, OR 97214-1308
Phone (503) 963-2846

Other identifiers 2

IdentifierTypeStateIssuer
1089895MedicaidWA
150698MedicaidOR

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)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
MD08438ORMDCardiovascular Disease Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Oregon Clinic, PC Past Accepting new patients
The Oregon Clinic PC Cardiovascular Disease Past Accepting new patients

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1124668800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1783900800000",
    "number": "1245222512",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "975 SE SANDY BLVD",
            "address_2": "SUITE 200",
            "city": "PORTLAND",
            "state": "OR",
            "postal_code": "972141308",
            "telephone_number": "503-963-2846",
            "fax_number": "503-963-9505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "24900 SE STARK ST",
            "address_2": "SUITE 103",
            "city": "GRESHAM",
            "state": "OR",
            "postal_code": "970303355",
            "telephone_number": "503-665-4278",
            "fax_number": "503-665-7766"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNJA",
        "first_name": "MANOHAR",
        "middle_name": "MULKI",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-08-22",
        "last_updated": "2026-07-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207RC0000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine, Cardiovascular Disease",
            "state": "OR",
            "license": "MD08438",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1089895",
            "state": "WA"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "150698",
            "state": "OR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Gresham, OR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 13, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.