Provider Demographics
NPI:1457309569
Name:OLSON, KURT RICHARD (MD)
Entity Type:Individual
Prefix:DR
First Name:KURT
Middle Name:RICHARD
Last Name:OLSON
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 1:1504 SAND POINT ROAD
Mailing Address - Street 2:
Mailing Address - City:MUNISING
Mailing Address - State:MI
Mailing Address - Zip Code:49862
Mailing Address - Country:US
Mailing Address - Phone:906-387-4220
Mailing Address - Fax:906-387-5449
Practice Address - Street 1:1504 SAND POINT ROAD
Practice Address - Street 2:
Practice Address - City:MUNISING
Practice Address - State:MI
Practice Address - Zip Code:49862
Practice Address - Country:US
Practice Address - Phone:906-387-4220
Practice Address - Fax:906-387-5449
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301058344207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0520128003OtherMEDICA PIN
MI07945OtherMCLAREN
MIKO058344OtherBLUE CROSS LICENSE
MI0800217321OtherBLUE CARE NETWORK PIN
MIXX27082OtherHEALTH PLUS PIN
MI0800217321OtherBLUE CROSS PIN
MI1669575148OtherMEDICAL ACCESS PROGRAM
MI3181170Medicaid
MI383165248100OtherCOMMUNITY CHOICE MI PIN
MIKO058344OtherFEDERAL BLUE CROSS PIN
MI507203OtherCARE CHOICES HMO PIN
MIQMXPR0017426OtherMOLINA HEALTHCARE OF MI
MI1007945OtherHEALTH ADVANTAGE PIN
MI197491012236OtherPREFERRED ONE PIN
MI07945OtherMCLAREN