Provider Demographics
NPI:1205801552
Name:OLAY, MICHAEL P (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:P
Last Name:OLAY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:416 W 15TH ST
Mailing Address - Street 2:BLDG 200
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3747
Mailing Address - Country:US
Mailing Address - Phone:405-471-6611
Mailing Address - Fax:405-471-5858
Practice Address - Street 1:416 W 15TH ST
Practice Address - Street 2:BLDG 200
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3747
Practice Address - Country:US
Practice Address - Phone:405-471-6611
Practice Address - Fax:405-471-5858
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-21
Last Update Date:2015-04-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK19464207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100168260CMedicaid
OK100168260CMedicaid
OKG28726Medicare UPIN