Individual
DR. BLAKE L OHLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
594 LONE TREE DR BLDG 6, MT PLEASANT, SC 29464-8170
(843) 958-2500
Mailing address
PO BOX 751649, CHARLOTTE, NC 28275-1649
(843) 789-1620
(843) 724-2440
Taxonomy
Speciality
Code
Description
License number
State
207X00000X
Orthopaedic Surgery Physician
Primary
30267
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
302675
—
SC
01
—
P00648648
RAILROAD MEDICARE ID
SC
01
—
P00811380
RAILROAD MEDICARE ID-RSFPN
SC
Enumeration date
05/01/2007
Last updated
05/11/2021
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