Provider Demographics
NPI:1265596308
Name:OLENICK, MORRY A (MD)
Entity type:Individual
Prefix:
First Name:MORRY
Middle Name:A
Last Name:OLENICK
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8515 PEARL ST STE 350
Mailing Address - Street 2:
Mailing Address - City:THORNTON
Mailing Address - State:CO
Mailing Address - Zip Code:80229-4832
Mailing Address - Country:US
Mailing Address - Phone:303-287-7007
Mailing Address - Fax:303-287-2230
Practice Address - Street 1:8515 PEARL ST STE 350
Practice Address - Street 2:
Practice Address - City:THORNTON
Practice Address - State:CO
Practice Address - Zip Code:80229-4832
Practice Address - Country:US
Practice Address - Phone:303-287-7007
Practice Address - Fax:303-287-2230
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-21
Last Update Date:2025-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO33789208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01337898Medicaid
E58805Medicare UPIN
69231Medicare ID - Type Unspecified