Individual
CHARLES S OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DO
Contact information
Practice address
128 MICHIGAN AVE, GLADSTONE, MI 49837-1929
(906) 428-4084
(906) 428-1881
Mailing address
128 MICHIGAN AVE, GLADSTONE, MI 49837-1929
(906) 428-4084
(906) 428-1881
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
5101013811
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4549419
—
MI
01
—
P00059355
RR MEDICARE GROUP#CC2139
MI
Enumeration date
08/05/2006
Last updated
07/08/2007
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