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General NPI Number Information
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NPI Number | 1518366178
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Entity Type | Organization
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Legal Business Name | AFFILIATED
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 5900 COLLEGE RD EKG-DEPT.
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City | KEY WEST
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State | FL
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Zip | 33040-4342
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Country | US
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Telephone | 305-295-3838
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Fax | 305-295-7772
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Provider Business Mailing Address
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Address Line | 3138 NORTHSIDE DR
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City | KEY WEST
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State | FL
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Zip | 33040-8028
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MR. ROBERT MICHAEL OLSON
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Credential | M.D.
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Telephone | 305-295-3838
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RC0000X
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Taxonomy Name | Cardiovascular Disease Physician
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License Number | ME0066579
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License Number State | FL
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