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NPI Code Detail

MEDICARE: MR. ANTHONY WAYNE OLDHAM

MEDICARE:  MR. ANTHONY WAYNE OLDHAM
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1247200000XOther Technician

General Provider Information

NPI Number : 1275508665
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ANTHONY WAYNE OLDHAM
Provider Business Mailing Address
First Line : 1267 DYER LAKE RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49684-8199
Country : US
Telephone Number : 231-922-8282
Fax Number : 231-922-8292
Provider Business Practice Location Address
First Line : 1175 AIRPORT ACCESS RD
Second Line :
City : TRAVERSE CITY
State : MI
Zip : 49686-3513
Country : US
Telephone Number : 231-922-8282
Fax Number : 231-922-8292
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/21/2006
Last Update Date : 07/08/2007

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Directions to “ MR. ANTHONY WAYNE OLDHAM ” Practice Location

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