Healthcare Provider Details

I. General information

NPI: 1013185750
Provider Name (Legal Business Name): M R OLDEN & ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2008
Last Update Date: 06/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 SUPERIOR AVE SUITE O
MUNSTER IN
46321-4037
US

IV. Provider business mailing address

PO BOX 631
RICHTON PARK IL
60471-0631
US

V. Phone/Fax

Practice location:
  • Phone: 219-922-4220
  • Fax: 219-922-4020
Mailing address:
  • Phone: 708-748-6775
  • Fax: 708-748-6775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number02000380A
License Number StateIN

VIII. Authorized Official

Name: DR. MICHAEL R OLDEN
Title or Position: PHYSICIAN
Credential: D.O.
Phone: 708-748-6775