Healthcare Provider Details

I. General information

NPI: 1811173412
Provider Name (Legal Business Name): DANIEL OLSEN DO
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/14/2008
Last Update Date: 09/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2000 BURTON ST SE
GRAND RAPIDS MI
49506-4670
US

IV. Provider business mailing address

2000 BURTON ST SE
GRAND RAPIDS MI
49506-4670
US

V. Phone/Fax

Practice location:
  • Phone: 616-241-5534
  • Fax: 616-241-4868
Mailing address:
  • Phone: 616-241-5534
  • Fax: 616-241-4868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207XS0106X
TaxonomyOrthopaedic Hand Surgery Physician
License NumberDO009921
License Number StateMI

VIII. Authorized Official

Name: DR. DANIEL J OLSEN
Title or Position: OWNER
Credential: D.O.
Phone: 616-241-5534