Provider Demographics
NPI:1225032196
Name:OLENECH, CHRIS M V (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHRIS
Middle Name:M
Last Name:OLENECH
Suffix:V
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3976 DIX HWY
Mailing Address - Street 2:
Mailing Address - City:LINCOLN PARK
Mailing Address - State:MI
Mailing Address - Zip Code:48146-3940
Mailing Address - Country:US
Mailing Address - Phone:313-386-5750
Mailing Address - Fax:313-386-0579
Practice Address - Street 1:3976 DIX HWY
Practice Address - Street 2:
Practice Address - City:LINCOLN PARK
Practice Address - State:MI
Practice Address - Zip Code:48146-3940
Practice Address - Country:US
Practice Address - Phone:313-386-5750
Practice Address - Fax:313-386-0579
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2011-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICO001358213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI107182OtherCARE CHOICES
MI4034087OtherAETNA
MI2733214Medicaid
MI480H219870OtherBLUE CARE NETWORK
MIQMXPR0036301OtherMOLINA
MI4858251630OtherBCBS
MI5825163OtherBCBS
MIC3706OtherM-CARE
MI1001793OtherCIGNA
MI480009053OtherRAILROAD MEDICARE
MI5825163OtherBCN
MIU06128OtherHAP
MI2733214Medicaid
MI5825163OtherBCBS
MI480H219870OtherBLUE CARE NETWORK
MI0612730001Medicare NSC
MI0P37330Medicare PIN