Healthcare Provider Details

I. General information

NPI: 1972581361
Provider Name (Legal Business Name): OLGA MARIC MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 10/04/2024
Certification Date: 10/04/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 SE 5TH TER
CRYSTAL RIVER FL
34429-4852
US

IV. Provider business mailing address

5400 PINEHURST DR
SPRING HILL FL
34606-3833
US

V. Phone/Fax

Practice location:
  • Phone: 352-699-2040
  • Fax: 352-699-2042
Mailing address:
  • Phone: 352-277-5305
  • Fax: 352-616-0926

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME89311
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: