Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Lake Grove ENT PC

Organization Otolaryngology Physician · NPI 1043211824

Lake Grove ENT PC is an Otolaryngology Physician in Lake Oswego, Oregon. Registered with an NPI since 2005.

In the registry since
2005
What do these letters mean?
PC — Professional corporation
A form of business registration, not a clinical qualification.

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Practice location Address checks out

17704 Jean Way Ste 101
Lake Oswego, OR 97035-5497
Phone: (503) 699-0370
Fax: (971) 236-9099
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Otolaryngology Physician (primary) Taxonomy 207Y00000X

Record details

NPI number1043211824
Entity typeOrganization (Type 2)
Organization subpartNo
Authorized official Cheryl Kruse — Clinic Manager · (503) 699-0370
NPI enumeratedAugust 3, 2005
Last updated in NPPESApril 4, 2022
Certification dateApril 4, 2022
Mailing address17704 Jean Way, Ste 101, Lake Oswego, OR 97035-5497

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