Healthcare Provider Details

I. General information

NPI: 1043254626
Provider Name (Legal Business Name): MARK WALTER OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2006
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1504 SAND POINT ROAD
MUNISING MI
49862
US

IV. Provider business mailing address

1504 SAND POINT ROAD
MUNISING MI
49862
US

V. Phone/Fax

Practice location:
  • Phone: 906-387-4220
  • Fax: 906-387-5449
Mailing address:
  • Phone: 906-387-4220
  • Fax: 906-387-5449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number4301058238
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: