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NPI Code Detail

MEDICARE: DR. CHARLES OLIVER IV PYSD

MEDICARE: DR. CHARLES OLIVER IV PYSD
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
1103TC0700XClinical Psychologist6351004590MI

General Provider Information

NPI Number : 1790549426
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CHARLES OLIVER IV PYSD
Provider Business Mailing Address
First Line : 2501 ROCHESTER CT
Second Line :
City : TROY
State : MI
Zip : 48083-1875
Country : US
Telephone Number : 248-764-9875
Fax Number :
Provider Business Practice Location Address
First Line : 2501 ROCHESTER CT
Second Line :
City : TROY
State : MI
Zip : 48083-1875
Country : US
Telephone Number : 248-891-8380
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/13/2024
Last Update Date : 02/13/2024

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Directions to “ DR. CHARLES OLIVER IV PYSD” Practice Location

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