Provider Demographics
NPI:1639188253
Name:OLSON, CAROLYN R (MD)
Entity Type:Individual
Prefix:
First Name:CAROLYN
Middle Name:R
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2845 US 2 AND 41
Mailing Address - Street 2:
Mailing Address - City:BARK RIVER
Mailing Address - State:MI
Mailing Address - Zip Code:49807-1929
Mailing Address - Country:US
Mailing Address - Phone:906-466-2000
Mailing Address - Fax:906-466-2067
Practice Address - Street 1:2845 US 2 AND 41
Practice Address - Street 2:
Practice Address - City:BARK RIVER
Practice Address - State:MI
Practice Address - Zip Code:49807-1929
Practice Address - Country:US
Practice Address - Phone:906-466-2000
Practice Address - Fax:906-466-2067
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2009-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301077170207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4969861Medicaid
MI4969861Medicaid
MI0M05250035Medicare ID - Type Unspecified