Obidike M Olisa, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

4301090895 Issued in MI

Practice address

N10565 Grandview LN
Ironwood, MI 49938-9622

Phone

(906) 932-1500

Fax

(906) 932-5630

NPI assigned

Jul 11, 2007

Last updated

Oct 5, 2007By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1184112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1191542400000",
    "number": "1184822181",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "N10565 GRANDVIEW LN",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499389622",
            "telephone_number": "906-932-1500",
            "fax_number": "906-932-5630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "N10565 GRANDVIEW LN",
            "city": "IRONWOOD",
            "state": "MI",
            "postal_code": "499389622",
            "telephone_number": "906-932-1500",
            "fax_number": "906-932-5630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLISA",
        "first_name": "OBIDIKE",
        "middle_name": "M",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2007-07-11",
        "last_updated": "2007-10-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "MI",
            "license": "4301090895",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "5208906",
            "state": "MI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "34934900",
            "state": "WI"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD MI",
            "identifier": "OO090895",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Michael David McPherson, PT, DPT
• Rebecca Lynn Mika, OTR
• Richard A Miller, OD
• J Michael Nelson, D.O.
• Heather Kirsten Nyman, NP-C
• Victoria Oliver, PHARMD
• Op Orthodontics of Minnesota PLLC (Carlson Orthodontics)
• Brianna Peige Orr, FNP-C
• Jon Ross Pagel, PHARMD
• Eric J Paul, PTA

• Family Medicine Physician in Ironwood, MI
• Providers in Ironwood, MI by specialty
• Family Medicine Physician in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.