Basic Information
| Provider Information | |||||||||
| NPI: | 1295173763 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KAMINSKY | ||||||||
| FirstName: | PAUL | ||||||||
| MiddleName: | MICHAEL | ||||||||
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| Credential: | MD/PHD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2222 NW LOVEJOY ST STE 322 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972105101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5039140024 | ||||||||
| FaxNumber: | 5039140025 | ||||||||
| Practice Location | |||||||||
| Address1: | 2222 NW LOVEJOY ST STE 601 | ||||||||
| Address2: | |||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 97210 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5034135514 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/06/2013 | ||||||||
| LastUpdateDate: | 02/17/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/17/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208C00000X | MD60979011 | WA | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | 135903 | FL | N | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery | 208C00000X | MD194774 | OR | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Colon & Rectal Surgery |
No ID Information.