Healthcare Provider Details

I. General information

NPI: 1740774421
Provider Name (Legal Business Name): MICHAEL OLENYCH MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2018
Last Update Date: 07/06/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8333 N DAVIS HWY
PENSACOLA FL
32514-6050
US

IV. Provider business mailing address

3601 4TH ST # A
LUBBOCK TX
79430-0002
US

V. Phone/Fax

Practice location:
  • Phone: 850-474-8015
  • Fax: 850-969-2840
Mailing address:
  • Phone: 806-743-2978
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberME159535
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: