Provider Demographics
NPI:1265612329
Name:CORDES, KATHLEEN K (MD)
Entity type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:K
Last Name:CORDES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 E 10TH AVE
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3317
Mailing Address - Country:US
Mailing Address - Phone:541-686-4153
Mailing Address - Fax:541-686-3468
Practice Address - Street 1:401 E 10TH AVE STE 250
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3362
Practice Address - Country:US
Practice Address - Phone:541-686-4153
Practice Address - Fax:541-686-3468
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR16009207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR072173Medicaid
ORR131120Medicare PIN
ORC45172Medicare UPIN
OR072173Medicaid