Provider Demographics
NPI:1225035678
Name:OLVEY, SCOTT PRESTON (MD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:PRESTON
Last Name:OLVEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 N CASALOMA DR
Mailing Address - Street 2:
Mailing Address - City:APPLETON
Mailing Address - State:WI
Mailing Address - Zip Code:54913-8284
Mailing Address - Country:US
Mailing Address - Phone:920-730-8833
Mailing Address - Fax:920-831-2968
Practice Address - Street 1:2323 N CASALOMA DR
Practice Address - Street 2:
Practice Address - City:APPLETON
Practice Address - State:WI
Practice Address - Zip Code:54913-8284
Practice Address - Country:US
Practice Address - Phone:920-730-8833
Practice Address - Fax:920-831-2968
Is Sole Proprietor?:No
Enumeration Date:2005-06-30
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI50492207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
000645232OtherRAILROAD MEDICARE
WI0555860001OtherNATIONAL GOVERNMENT SERVI
WI34799300Medicaid
WI0555860001OtherNATIONAL GOVERNMENT SERVI
I08564Medicare UPIN