Individual
CHARLES O OLISA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
445 E FM 1382, SUITE 3- 265, CEDAR HILL, TX 75104
(469) 744-8844
Mailing address
445 E FM 1382, SUITE 3 - 265, CEDAR HILL, TX 75104-5104
(469) 744-8844
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
01066108A
IN
208M00000X
Hospitalist Physician
01066108A
IN
208M00000X
Hospitalist Physician
Primary
MD205030
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
008839400
—
FL
01
—
11948268
CAQH
IN
Enumeration date
01/12/2007
Last updated
01/11/2024
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