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Contact Information

HAGEN KENNECKE, MD, MHA, FRCPC
1130 NW 22ND AVE STE 150
PORTLAND, OR97210-2974
 Phone: 971-262-9600
 Fax: 971-262-9601
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Medical Oncology

207RX0202X 11 Physician/Internal Medicine
 

Hematology & Oncology

207RH0003X 11 Physician/Internal Medicine
Indicates primary specialty

NPI Profile & details for HAGEN KENNECKE · (Male)

NPI # 1578090270
Status Active
Credentials MD, MHA, FRCPC
Entity Individual
Enumeration date 05/12/2017
Last updated 02/06/2024 - About 2 years ago
Sole proprietor 1 No
Identifiers
  • OR License # MD203393
  • WA License # 60729732
Hospital affiliation(s)
  • PROVIDENCE PORTLAND MEDICAL CENTER - (Acute Care)
    4805 NE GLISAN STREET
    PORTLAND, OR 97213
1 A sole proprietor/sole proprietorship is an individual, and as such, is eligible for a single NPI number. The sole proprietor must apply for the NPI number using his or her own Social Security Number (SSN), not an Employer Identification Number (EIN) even if he/she has an EIN.

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