Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RP1001X | Pulmonary Disease | 17056 | AL |
NPI | 1043243264 |
---|---|
Provider Name | Mitchell A Olman |
First Address | Cleveland, OH 44195 |
Second Address | Cleveland, OH 44195-0001 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2006 |
Last Update Date | 22/06/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
000085031 | (05) | AL |
000085031 | BLUE CROSS (01) | AL |
06253774 | MISSISSIPPI MEDICAID (01) | MS |
290004750 | RAILROAD MEDICARE (01) | AL |
A53607 | VIVA (01) | AL |