Individual
DEREK OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
4444 KALAMAZOO AVE SE STE 200, KENTWOOD, MI 49508
(616) 391-5600
Mailing address
100 MICHIGAN ST NE # MC845, GRAND RAPIDS, MI 49503-2560
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
5101014512
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036113363
—
IL
Enumeration date
01/23/2006
Last updated
02/25/2021
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