Provider Demographics
NPI:1710118963
Name:OLARTE, IVAN GUILLERMO (MD)
Entity Type:Individual
Prefix:
First Name:IVAN
Middle Name:GUILLERMO
Last Name:OLARTE
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 1:18344 MURDOCK CIR
Mailing Address - Street 2:
Mailing Address - City:PORT CHARLOTTE
Mailing Address - State:FL
Mailing Address - Zip Code:33948-1008
Mailing Address - Country:US
Mailing Address - Phone:941-625-6547
Mailing Address - Fax:941-629-6415
Practice Address - Street 1:18344 MURDOCK CIR
Practice Address - Street 2:
Practice Address - City:PORT CHARLOTTE
Practice Address - State:FL
Practice Address - Zip Code:33948-1008
Practice Address - Country:US
Practice Address - Phone:941-625-6547
Practice Address - Fax:941-629-6415
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME110134207XS0106X
MI4301085888208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14FR5OtherBLUE CROSS BLUE SHIELD