Provider Demographics
NPI:1043356710
Name:OLECHOWSKI, RALPH A (DO)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:A
Last Name:OLECHOWSKI
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:75 REMIT DRIVE
Mailing Address - Street 2:LOCKBOX 6900
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60675-6900
Mailing Address - Country:US
Mailing Address - Phone:866-916-5259
Mailing Address - Fax:231-922-4030
Practice Address - Street 1:3401 LUDINGTON ST
Practice Address - Street 2:
Practice Address - City:ESCANABA
Practice Address - State:MI
Practice Address - Zip Code:49829-1300
Practice Address - Country:US
Practice Address - Phone:906-786-5707
Practice Address - Fax:906-786-4004
Is Sole Proprietor?:No
Enumeration Date:2007-01-30
Last Update Date:2008-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101006590207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010060046OtherRAILROAD MEDICARE
MIP00434632OtherRAILROAD MEDICARE
MI1043356710Medicaid
MI3469672Medicaid
MI1043356710Medicaid
MI3469672Medicaid
P70283Medicare UPIN