Provider Demographics
NPI:1790971562
Name:KARLEEN SWARZTRAUBER LLC
Entity Type:Organization
Organization Name:KARLEEN SWARZTRAUBER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:KARLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SWARZTRAUBER
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MPH
Authorized Official - Phone:971-404-3366
Mailing Address - Street 1:PO BOX 19266
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97280-0266
Mailing Address - Country:US
Mailing Address - Phone:971-404-3366
Mailing Address - Fax:971-404-3377
Practice Address - Street 1:6485 SW BORLAND RD
Practice Address - Street 2:SUITE B
Practice Address - City:TUALATIN
Practice Address - State:OR
Practice Address - Zip Code:97062-9762
Practice Address - Country:US
Practice Address - Phone:503-783-3090
Practice Address - Fax:503-363-1284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-14
Last Update Date:2009-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD22724208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
G02208Medicare UPIN