Healthcare Provider Details

I. General information

NPI: 1619294386
Provider Name (Legal Business Name): MICHAEL JESSE HENDRICKS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/21/2010
Last Update Date: 03/31/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3181 SW SAM JACKSON PARK RD UNIVERSITY MEDICAL GROUP, OHSU
PORTLAND OR
97239-3011
US

IV. Provider business mailing address

3181 SW SAM JACKSON PARK RD UNIVERSITY MEDICAL GROUP, OHSU
PORTLAND OR
97239-3011
US

V. Phone/Fax

Practice location:
  • Phone: 408-885-6305
  • Fax:
Mailing address:
  • Phone: 503-494-9000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License NumberMD167305
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: