Michael P. Gardner, MD PC

Primary specialty

Urology PhysicianTaxonomy code 208800000X

License

MD22270 Issued in OR

Legal business name

MICHAEL P. GARDNER, MD PC

Practice address

19260 SW 65TH Ave Ste 310
Tualatin, OR 97062-5710

Phone

(503) 692-1200

Fax

(503) 692-1220

NPI assigned

Nov 23, 2007

Organization subpart

No

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

Authorized official

Name

Shelly Banta

Title

Office Manager

Phone

(503) 334-5958

Specialties & licenses 1

Addresses

Other identifiers 2

Other names 1

• Oregon Urology Alliance Doing business as

Medicare fee-for-service enrollment

Enrolled in OR

Enrollment records 1

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Michael Paul Gardner, M.D.

  • Urology Physician
  • Tualatin, OR
  • NPI 1215993845
  Medicare reassignment NPD

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

{
    "created_epoch": "1195776000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704672000000",
    "number": "1437330180",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 310",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625710",
            "telephone_number": "503-692-1200",
            "fax_number": "503-692-1220"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "19260 SW 65TH AVE STE 310",
            "city": "TUALATIN",
            "state": "OR",
            "postal_code": "970625710",
            "telephone_number": "503-692-1200",
            "fax_number": "503-692-1220"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MICHAEL P. GARDNER, MD PC",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-11-23",
        "last_updated": "2024-01-08",
        "certification_date": "2024-01-08",
        "status": "A",
        "authorized_official_last_name": "BANTA",
        "authorized_official_first_name": "SHELLY",
        "authorized_official_title_or_position": "OFFICE MANAGER",
        "authorized_official_telephone_number": "503-334-5958"
    },
    "taxonomies": [
        {
            "code": "208800000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Urology",
            "state": "OR",
            "license": "MD22270",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "288387",
            "state": "OR"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "OMAP NUMBER",
            "identifier": "288387",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Oregon Urology Alliance",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Meridian Park Radiation Oncology Center, Inc.
• Samantha Merz
• Metatron Health LLC
• MFT Holdings, LLC
• Michael P. Gardner, MD PC
• Michael R Van Allen MD PC
• Michael W. Gehlen D.M.D.,P.C.
• Suzanne L Migchelbrink, MD
• Tatyana Mikhlina, LMT
• Ashley Mildren, DPT

• Urology Physician in Tualatin, OR
• Providers in Tualatin, OR by specialty
• Urology Physician in Oregon

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.