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NPI Code Detail

MEDICARE: MR. OLAN C DOMBROSKE DO

MEDICARE: MR. OLAN C DOMBROSKE DO
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
1207Q00000XFamily Medicine Physician0D008339 5101008339MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10157600104OTHERMIBLUE CROSS BLUE SHIELD
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1568452811
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. OLAN C DOMBROSKE DO
Provider Business Mailing Address
First Line : 7115 CADE RD
Second Line :
City : BROWN CITY
State : MI
Zip : 48416-9778
Country : US
Telephone Number : 810-346-2757
Fax Number : 810-346-2016
Provider Business Practice Location Address
First Line : 7115 CADE RD
Second Line :
City : BROWN CITY
State : MI
Zip : 48416-9778
Country : US
Telephone Number : 810-346-2757
Fax Number : 810-346-2016
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/27/2005
Last Update Date : 07/08/2007

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Directions to “ MR. OLAN C DOMBROSKE DO” Practice Location

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