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NPI Code Detail

MEDICARE: KAREN SUE ULLOTH M.D.

MEDICARE: KAREN SUE ULLOTH M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208600000XSurgery PhysicianMD16793OR

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1235181439
Entity Type Code : Individual
Provider Name (Legal Business Name) : KAREN SUE ULLOTH M.D.
Provider Business Mailing Address
First Line : 2222 NW LOVEJOY ST
Second Line : SUITE 322
City : PORTLAND
State : OR
Zip : 97210-5101
Country : US
Telephone Number : 503-229-7224
Fax Number : 503-229-8175
Provider Business Practice Location Address
First Line : 2222 NW LOVEJOY ST
Second Line : SUITE 322
City : PORTLAND
State : OR
Zip : 97210-5101
Country : US
Telephone Number : 503-229-7224
Fax Number : 503-229-8175
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/16/2006
Last Update Date : 11/18/2011

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Directions to “ KAREN SUE ULLOTH M.D.” Practice Location

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