| Christopher Hatlestad, MD, PC | |
|
1221 Se Madison St Portland OR 97214-3890 | |
| (503) 212-4488 | |
| (503) 212-4495 |
| Full Name | Christopher Hatlestad, MD, PC |
|---|---|
| Speciality | Clinic/center - Primary Care |
| Location | 1221 Se Madison St, Portland, Oregon |
| Authorized Official Name and Position | Christopher Lien Hatlestad (PRESIDENT) |
| Authorized Official Contact | 5419480303 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Christopher Hatlestad, MD, PC 1221 Se Madison St Portland OR 97214-3890 Ph: (503) 212-4488 | Christopher Hatlestad, MD, PC 1221 Se Madison St Portland OR 97214-3890 Ph: (503) 212-4488 |
| NPI Number | 1083096929 |
|---|---|
| Provider Enumeration Date | 06/28/2015 |
| Last Update Date | 11/17/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1083096929 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | MD24066 (Oregon) | Primary |
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