MEDICARE: DR. RONALD KEVIN OLM DPM, FACFAS, C-PED

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	213E00000X	Podiatrist	5901001664	MI
2	213E00000X	Podiatrist	R0001664	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1356344741
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RONALD KEVIN OLM DPM, FACFAS, C-PED

Provider Business Mailing Address
First Line	:	4246 3 MILE RD N
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9195
Country	:	US
Telephone Number	:	231-922-9100
Fax Number	:	231-922-9180

Provider Business Practice Location Address
First Line	:	4246 3 MILE RD N
Second Line	:
City	:	TRAVERSE CITY
State	:	MI
Zip	:	49686-9195
Country	:	US
Telephone Number	:	231-922-9100
Fax Number	:	231-922-9180

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2005
Last Update Date	:	06/26/2013

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