Healthcare Provider Details

I. General information

NPI: 1982307963
Provider Name (Legal Business Name): MRS. CASANDRA R OLBRYS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

28303 DEQUINDRE RD
MADISON HEIGHTS MI
48071-3040
US

IV. Provider business mailing address

22120 MAUER ST
SAINT CLAIR SHORES MI
48080-3546
US

V. Phone/Fax

Practice location:
  • Phone: 248-658-1116
  • Fax:
Mailing address:
  • Phone: 586-738-8720
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: