Provider Demographics
NPI:1811985658
Name:OLGAARD, MARK K (DO)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:K
Last Name:OLGAARD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:PO BOX 779
Mailing Address - Street 2:
Mailing Address - City:TAWAS CITY
Mailing Address - State:MI
Mailing Address - Zip Code:48764-0779
Mailing Address - Country:US
Mailing Address - Phone:989-362-0153
Mailing Address - Fax:989-362-4683
Practice Address - Street 1:302 S MAIN ST
Practice Address - Street 2:
Practice Address - City:AU GRES
Practice Address - State:MI
Practice Address - Zip Code:48703-8700
Practice Address - Country:US
Practice Address - Phone:989-876-7104
Practice Address - Fax:989-876-2881
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008757207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3516709Medicaid
MIOM73810Medicare ID - Type Unspecified
MI3516709Medicaid