Provider Demographics
NPI:1649211012
Name:SAETRUM OPGAARD, OLE (MD, PHD)
Entity Type:Individual
Prefix:
First Name:OLE
Middle Name:
Last Name:SAETRUM OPGAARD
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 12259
Mailing Address - Street 2:
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92685-2259
Mailing Address - Country:US
Mailing Address - Phone:949-228-6387
Mailing Address - Fax:714-786-5799
Practice Address - Street 1:9191 WESTMINSTER AVE STE 207
Practice Address - Street 2:
Practice Address - City:GARDEN GROVE
Practice Address - State:CA
Practice Address - Zip Code:92844-2751
Practice Address - Country:US
Practice Address - Phone:714-786-5794
Practice Address - Fax:714-786-5799
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2021-03-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA85270207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI63404Medicare UPIN
CAWA85270BMedicare PIN