Healthcare Provider Details

I. General information

NPI: 1922027770
Provider Name (Legal Business Name): CHRISTOPHER LIEN HATLESTAD MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHRIS LIEN HATLESTAD MD

II. Dates (important events)

Enumeration Date: 07/19/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17685 65TH AVE SUITE 300
LAKE OSWEGO OR
97035-7800
US

IV. Provider business mailing address

1221 SE MADISON ST SUITE 300
PORTLAND OR
97214-3890
US

V. Phone/Fax

Practice location:
  • Phone: 503-747-2021
  • Fax: 503-747-2802
Mailing address:
  • Phone: 503-212-4488
  • Fax: 503-212-4495

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD24066
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: