Lake Grove Ent PC
NPI #1043211824 in Lake Oswego, Oregon
Provider Information
- NPI Number
- 1043211824
- Entity Type
- Organization
- Organization Name
- Lake Grove Ent PC
- Primary Specialty
- Otolaryngology
- Enumeration Date
- Aug 3, 2005
- Last Updated
- Apr 4, 2022
Practice Location
- Address
- 17704 JEAN WAY
- Address 2
- STE 101
- City
- Lake Oswego
- State
- Oregon
- ZIP Code
- 97035-5497
- Phone
- (503) 699-0370
Authorized Official
- Name
- CHERYL LEE KRUSE
- Title
- CLINIC MANAGER
- Phone
- (503) 699-0370
Specialties & Taxonomy Codes
| Specialty |
|---|
| Otolaryngology |
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