Provider Demographics
NPI:1083826812
Name:LUEPSCHEN, OLGA M (DPM)
Entity Type:Individual
Prefix:
First Name:OLGA
Middle Name:M
Last Name:LUEPSCHEN
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 RYANT BLVD
Mailing Address - Street 2:
Mailing Address - City:SEBRING
Mailing Address - State:FL
Mailing Address - Zip Code:33870-8075
Mailing Address - Country:US
Mailing Address - Phone:863-314-9255
Mailing Address - Fax:863-314-0055
Practice Address - Street 1:2 RYANT BLVD
Practice Address - Street 2:
Practice Address - City:SEBRING
Practice Address - State:FL
Practice Address - Zip Code:33870-8075
Practice Address - Country:US
Practice Address - Phone:863-314-9255
Practice Address - Fax:863-314-0055
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2009-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPO2380213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
043678136OtherCORPORATE TAX ID
FL390181500Medicaid
FL65339OtherBLUE CROSS BLUE SHIELD
480034505OtherMEDICARE RAILROAD
043678136OtherCORPORATE TAX ID
FL390181500Medicaid
FL65339OtherBLUE CROSS BLUE SHIELD