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18514 Se Wilmot St Unit B Milwaukie OR 97267-6426 | |
| (678) 793-8808 | |
| Not Available |
| Full Name | |
|---|---|
| Speciality | Family Medicine |
| Location | 18514 Se Wilmot St Unit B, Milwaukie, Oregon |
| Authorized Official Name and Position | Berhanu Ejigu Kededa (OWNER, DIRECTOR) |
| Authorized Official Contact | 6787938808 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
18514 Se Wilmot St Unit B Milwaukie OR 97267-6426 Ph: (678) 793-8808 | 18514 Se Wilmot St Unit B Milwaukie OR 97267-6426 Ph: (678) 793-8808 |
| NPI Number | 1629899448 |
|---|---|
| Provider Enumeration Date | 10/23/2024 |
| Last Update Date | 11/26/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1629899448 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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