Healthcare Provider Details

I. General information

NPI: 1396431474
Provider Name (Legal Business Name): CASCADE REGENERATIVE MEDICINE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2023
Last Update Date: 04/12/2023
Certification Date: 04/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6420 S MACADAM AVE STE 208
PORTLAND OR
97239-3518
US

IV. Provider business mailing address

6420 S MACADAM AVE STE 208
PORTLAND OR
97239-3518
US

V. Phone/Fax

Practice location:
  • Phone: 503-841-5292
  • Fax:
Mailing address:
  • Phone: 503-841-5292
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code204C00000X
TaxonomySports Medicine (Neuromusculoskeletal Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. SAMUEL OLTMAN
Title or Position: OWNER/PHYSICIAN
Credential: ND, RMSK
Phone: 503-914-8455