MEDICARE: DR. KATHERINE M DAHLKE MD

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
1	207R00000X	Internal Medicine Physician	MD18119	OR

General Provider Information

NPI Number	:	1598830812
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KATHERINE M DAHLKE MD

Provider Business Mailing Address
First Line	:	2121 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1522
Country	:	US
Telephone Number	:	503-234-7299
Fax Number	:	503-234-9639

Provider Business Practice Location Address
First Line	:	2121 NE HALSEY ST
Second Line	:
City	:	PORTLAND
State	:	OR
Zip	:	97232-1522
Country	:	US
Telephone Number	:	503-234-7299
Fax Number	:	503-234-9639

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/21/2006
Last Update Date	:	02/11/2020

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