Provider Demographics
NPI:1811173412
Name:DANIEL OLSEN DO
Entity type:Organization
Organization Name:DANIEL OLSEN DO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:OLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:616-241-5534
Mailing Address - Street 1:2000 BURTON ST SE
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49506-4670
Mailing Address - Country:US
Mailing Address - Phone:616-241-5534
Mailing Address - Fax:616-241-4868
Practice Address - Street 1:2000 BURTON ST SE
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49506-4670
Practice Address - Country:US
Practice Address - Phone:616-241-5534
Practice Address - Fax:616-241-4868
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-14
Last Update Date:2015-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIDO009921207XS0106X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0106XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryHand SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1396700761OtherNPI
MI2880701Medicaid
F40899Medicare UPIN
MIOP49880Medicare PIN