Active NPI
Michael Philip Resnick, MD
- Addiction Medicine (Psychiatry & Neurology) Physician
- Portland, OR
National Provider Identifier
1467545996
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Addiction Medicine (Psychiatry & Neurology) Physician
- License
- 09333
- Practice address
- 3181 Ssam Jackson Park Rd
Portland, OR 97207 - Phone
- (503) 220-8262
- Fax
- (360) 737-1419
- NPI assigned
- Oct 2, 2006
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Addiction Medicine (Psychiatry & Neurology) Physician | 2084A0401X | 09333 | OR | Primary |
Addresses
Primary practice location
3181 Ssam Jackson Park Rd
Portland, OR 97207
Mailing address
3491 NW Raleigh St
Portland, OR 97210
Phone (503) 220-8262
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
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 09333 | OR | MD | Addiction Medicine (Psychiatry & Neurology) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1159747200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1467545996",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3491 NW RALEIGH ST",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97210",
"telephone_number": "503-220-8262",
"fax_number": "360-737-1419"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3181 SSAM JACKSON PARK RD",
"city": "PORTLAND",
"state": "OR",
"postal_code": "97207",
"telephone_number": "503-220-8262",
"fax_number": "360-737-1419"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RESNICK",
"first_name": "MICHAEL",
"middle_name": "PHILIP",
"name_prefix": "Dr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-10-02",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "2084A0401X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Addiction Medicine",
"state": "OR",
"license": "09333",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Portland, OR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.