Provider Demographics
NPI:1356344741
Name:OLM, RONALD KEVIN (DPM, FACFAS, C-PED)
Entity type:Individual
Prefix:DR
First Name:RONALD
Middle Name:KEVIN
Last Name:OLM
Suffix:
Gender:M
Credentials:DPM, FACFAS, C-PED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4246 3 MILE RD N
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-9195
Mailing Address - Country:US
Mailing Address - Phone:231-922-9100
Mailing Address - Fax:231-922-9180
Practice Address - Street 1:4246 3 MILE RD N
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-9195
Practice Address - Country:US
Practice Address - Phone:231-922-9100
Practice Address - Fax:231-922-9180
Is Sole Proprietor?:Yes
Enumeration Date:2005-05-31
Last Update Date:2013-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901001664213E00000X
MIR0001664213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI(13)2893049Medicaid
MI2893049Medicaid
MIU13351Medicare UPIN
MI(13)2893049Medicaid
MI2893049Medicaid
MI4557980001Medicare NSC