Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2086S0105X | Surgery of the Hand | DO009921 | MI |
NPI | 1396700761 |
---|---|
Provider Name | Daniel J Olsen |
First Address | Grand Rapids, MI 49506-4670 |
Second Address | Grand Rapids, MI 49506-4670 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 19/04/2006 |
Last Update Date | 08/09/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2880701 | (05) | MI |
F40899 | (02) | MI |