Provider Demographics
NPI:1013185750
Name:M R OLDEN & ASSOCIATES LLC
Entity Type:Organization
Organization Name:M R OLDEN & ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:R
Authorized Official - Last Name:OLDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:708-748-6775
Mailing Address - Street 1:PO BOX 631
Mailing Address - Street 2:
Mailing Address - City:RICHTON PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60471-0631
Mailing Address - Country:US
Mailing Address - Phone:708-748-6775
Mailing Address - Fax:708-748-6775
Practice Address - Street 1:701 SUPERIOR AVE
Practice Address - Street 2:SUITE O
Practice Address - City:MUNSTER
Practice Address - State:IN
Practice Address - Zip Code:46321-4037
Practice Address - Country:US
Practice Address - Phone:219-922-4220
Practice Address - Fax:219-922-4020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-15
Last Update Date:2010-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN02000380A207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL210657Medicare PIN
IN141990Medicare PIN