Provider Demographics
NPI:1235100926
Name:DALL'OLMO, CARLO A (MD)
Entity Type:Individual
Prefix:
First Name:CARLO
Middle Name:A
Last Name:DALL'OLMO
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 1:5020 W BRISTOL RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-2919
Mailing Address - Country:US
Mailing Address - Phone:810-732-1620
Mailing Address - Fax:810-732-8559
Practice Address - Street 1:5020 W BRISTOL RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48507-2919
Practice Address - Country:US
Practice Address - Phone:810-732-1620
Practice Address - Fax:810-732-8559
Is Sole Proprietor?:No
Enumeration Date:2006-01-30
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MICD0296822086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI382237803111OtherCOMMUNITY CHOICE
MIB42956OtherHEALTH ALLIANCE PLAN
MI0615552OtherHEALTHPLUS OF MICHIGAN
MI105229OtherPREFERRED CHOICE PPO
MI1430928Medicaid
MI105229OtherCARE CHOICE HMO
MI117047OtherGREAT LAKES HEALTH PLAN
MI204103OtherMCLAREN HEALTH PLAN/ADVAN
MI4294592OtherAETNA
MIC3723OtherM-CARE
ME0202515552OtherBC/BS OF MICHIGAN
MI0615552OtherHEALTHPLUS OF MICHIGAN
MIC3723OtherM-CARE