Healthcare Provider Details

I. General information

NPI: 1356800536
Provider Name (Legal Business Name): KATHERINE JO LUTZ MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE JO JENSEN

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 SE MAIN ST STE 60
PORTLAND OR
97216-2461
US

IV. Provider business mailing address

1400 SW 5TH AVE STE 500
PORTLAND OR
97201-5537
US

V. Phone/Fax

Practice location:
  • Phone: 503-257-0959
  • Fax: 503-256-7757
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RI0011X
TaxonomyInterventional Cardiology Physician
License NumberMD200660
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: