Provider Demographics
NPI:1508822701
Name:DOLD, OLIVER N (MD)
Entity Type:Individual
Prefix:DR
First Name:OLIVER
Middle Name:N
Last Name:DOLD
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:2300 N EDWARD ST
Mailing Address - Street 2:GSBLL
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62526-4163
Mailing Address - Country:US
Mailing Address - Phone:217-876-2780
Mailing Address - Fax:217-876-2785
Practice Address - Street 1:2 MEMORIAL DR
Practice Address - Street 2:STE 207
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62526-3950
Practice Address - Country:US
Practice Address - Phone:217-876-2780
Practice Address - Fax:217-876-2785
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2014-09-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IL036090811207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILK04859Medicare ID - Type Unspecified
IL036090811Medicaid
ILG13256Medicare UPIN