Healthcare Provider Details

I. General information

NPI: 1407210206
Provider Name (Legal Business Name): CHARLES HILLENBRAND MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/07/2016
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3920 CAPITAL MALL DR SW STE 203
OLYMPIA WA
98502-8702
US

IV. Provider business mailing address

PO BOX 5299 MS: 820-5-PCO
TACOMA WA
98415-0299
US

V. Phone/Fax

Practice location:
  • Phone: 360-754-3507
  • Fax: 360-236-9662
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License NumberMD61435811
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: