Provider Demographics
NPI:1578663191
Name:OLIVI, JOE A (MD)
Entity Type:Individual
Prefix:
First Name:JOE
Middle Name:A
Last Name:OLIVI
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9430 TURKEY LAKE RD STE 114
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32819-8015
Mailing Address - Country:US
Mailing Address - Phone:407-354-1202
Mailing Address - Fax:407-351-8801
Practice Address - Street 1:9430 TURKEY LAKE RD STE 114
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-8015
Practice Address - Country:US
Practice Address - Phone:407-354-1202
Practice Address - Fax:407-351-8801
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
ARE11250208600000X
MO2008035007208600000X
FLME152122208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL111433200Medicaid
MO200057404Medicaid