Healthcare Provider Details

I. General information

NPI: 1346476835
Provider Name (Legal Business Name): DAIVA OLIPRA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2009
Last Update Date: 09/11/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 OAKLAND DR
KALAMAZOO MI
49008-1282
US

IV. Provider business mailing address

2710 HARNEY ST STE 100
LARAMIE WY
82072-0001
US

V. Phone/Fax

Practice location:
  • Phone: 269-337-4400
  • Fax:
Mailing address:
  • Phone: 307-745-1461
  • Fax: 307-745-8167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4301093921
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number4301093921
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: