Healthcare Provider Details

I. General information

NPI: 1437491040
Provider Name (Legal Business Name): MARC OLSHAN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 09/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 SW 152ND ST
PALMETTO BAY FL
33157
US

IV. Provider business mailing address

PO BOX 12493
MIAMI FL
33101-2493
US

V. Phone/Fax

Practice location:
  • Phone: 305-256-5001
  • Fax:
Mailing address:
  • Phone: 305-585-5315
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number136573
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: