Provider Demographics
NPI:1194712182
Name:KAEMPF, MICHAEL JEROME (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:JEROME
Last Name:KAEMPF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:847 NE 19TH AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97232-2684
Mailing Address - Country:US
Mailing Address - Phone:503-963-2801
Mailing Address - Fax:503-963-2825
Practice Address - Street 1:1130 NW 22ND AVE
Practice Address - Street 2:STE 535
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97210-2976
Practice Address - Country:US
Practice Address - Phone:503-274-4999
Practice Address - Fax:503-796-9884
Is Sole Proprietor?:No
Enumeration Date:2005-10-04
Last Update Date:2021-12-06
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
ORMD10240208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR104562Medicaid
WA7858004Medicaid
OR109371Medicaid
OR104562Medicaid
OR109371Medicaid
WA1421502Medicaid
WA7858004Medicaid
WA079880OtherDEPT OF LABOR A
WA43747OtherDEPT OF LABOR A
930766376OtherCAREOREGON
K588AOtherHEALTH NET
003395007OtherBLUE CROSS OR ALL
C91739OtherPROVIDENCE HEALTH
756341096Medicare ID - Type UnspecifiedMEDICARE RAILROAD
CP7690Medicare ID - Type UnspecifiedMEDICARE RAILROAD
003395000OtherBLUE CROSS OR ALL
003395007OtherBLUE CROSS OR ALL
WA43747OtherDEPT OF LABOR A
WA079880OtherDEPT OF LABOR A
C91739OtherPROVIDENCE HEALTH
OR183579Medicare PIN