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NPI Code Detail

MEDICARE: MARC A OLSEN MD

MEDICARE: MARC A OLSEN MD
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 Physician21628WI

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1P00450900OTHERWIRR MEDICARE

Other Identifiers

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

General Provider Information

NPI Number : 1952333148
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARC A OLSEN MD
Provider Business Mailing Address
First Line : 3003 W GOOD HOPE ROAD
Second Line :
City : MILWAUKEE
State : WI
Zip : 53209
Country : US
Telephone Number : 414-352-3100
Fax Number : 414-247-4590
Provider Business Practice Location Address
First Line : 325 E SILVER SPRING DR
Second Line :
City : WHITEFISH BAY
State : WI
Zip : 53217-5222
Country : US
Telephone Number : 414-247-4800
Fax Number : 414-247-4801
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2006
Last Update Date : 12/28/2010

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