Provider Demographics
NPI:1205885977
Name:OLSON, STEPHEN M (DO)
Entity type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:M
Last Name:OLSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:37400 GARFIELD RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CLINTON TOWNSHIP
Mailing Address - State:MI
Mailing Address - Zip Code:48036-3648
Mailing Address - Country:US
Mailing Address - Phone:586-286-4880
Mailing Address - Fax:586-286-1102
Practice Address - Street 1:32901 23 MILE RD
Practice Address - Street 2:STE. 120
Practice Address - City:CHESTERFIELD
Practice Address - State:MI
Practice Address - Zip Code:48047-4063
Practice Address - Country:US
Practice Address - Phone:586-725-4604
Practice Address - Fax:586-725-3021
Is Sole Proprietor?:No
Enumeration Date:2006-05-09
Last Update Date:2020-05-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101011971207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4810054Medicaid
MI1022826OtherMHP HAN
MI160D410050OtherBCBS BCN BLUE CHOICE
MI4177977Medicaid
MI4830413Medicaid
MIG56249Medicare UPIN
MI4177977Medicaid