Provider Demographics
NPI:1649364696
Name:ESHRAGHI, NIKNAM NMI (MD)
Entity type:Individual
Prefix:
First Name:NIKNAM
Middle Name:NMI
Last Name:ESHRAGHI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:541 NE 20TH AVE STE 225
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2895
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:501 N GRAHAM ST STE 555
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97227-2007
Practice Address - Country:US
Practice Address - Phone:503-288-7535
Practice Address - Fax:503-288-7538
Is Sole Proprietor?:No
Enumeration Date:2006-10-03
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD18913208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1649364696Medicaid
OR150227Medicaid
104618Medicare UPIN
OR164893Medicare PIN
OR150227Medicaid
WA1649364696Medicaid