Provider Demographics
NPI:1114917887
Name:OLSON, DARLA M (MD)
Entity Type:Individual
Prefix:
First Name:DARLA
Middle Name:M
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:100 MICHIGAN ST NE
Mailing Address - Street 2:MC 845
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49503-2560
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8333 FELCH ST
Practice Address - Street 2:SUITE 202
Practice Address - City:ZEELAND
Practice Address - State:MI
Practice Address - Zip Code:49464-2608
Practice Address - Country:US
Practice Address - Phone:616-748-2850
Practice Address - Fax:616-772-2671
Is Sole Proprietor?:No
Enumeration Date:2005-10-25
Last Update Date:2023-05-03
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301053201207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI2870106Medicaid
MIF42056Medicare UPIN
MIM74460814Medicare PIN