Organization
NORTHWESTERN NEUROLOGICAL ASSOC PC
Active
Other names
Northwestern Neurological Associates PC
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KENT MICHAEL GREWE MD (OWNER)
(503) 288-5151
Entity
Organization
Contact information
Practice address
501 N GRAHAM ST, SUITE 545, PORTLAND, OR 97227-1654
(503) 288-5151
(503) 288-4942
Mailing address
501 N GRAHAM ST, SUITE 545, PORTLAND, OR 97227-1654
(503) 288-5151
(503) 288-4942
Taxonomy
Speciality
Code
Description
License number
State
207T00000X
Neurological Surgery Physician
Primary
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
001782000
BCBS
—
05
—
004197
—
OR
01
—
R0000WCJVQ
PTAN
OR
Enumeration date
02/09/2006
Last updated
02/11/2025
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