Active NPI
Lucila W. Olson, M.D.
- Pediatrics Physician
- Clinton Township, MI
National Provider Identifier
1669420949
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pediatrics Physician
- License
- 4301058057
- Practice address
- 36500 S Gratiot Ave
Ste. 101
Clinton Township, MI 48035-1772 - Phone
- (586) 493-3732
- Fax
- (586) 493-3739
- NPI assigned
- May 5, 2006
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pediatrics Physician | 208000000X | 4301058057 | MI | Primary |
Addresses
Primary practice location
36500 S Gratiot Ave
Ste. 101
Clinton Township, MI 48035-1772
Mailing address
401 S Ballenger Hwy
Flint, MI 48532-3638
Phone (810) 342-1000
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 3225102 | Medicaid | MI | |
| 350D410030 | Other | MI | BCBS BCN COMM BLUE |
| 3225096 | Medicaid | MI | |
| 4956934 | Medicaid | MI | |
| 1022817 | Other | MI | MHP HAN |
| 4682809 | Medicaid | MI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1669420949",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "401 S BALLENGER HWY",
"city": "FLINT",
"state": "MI",
"postal_code": "485323638",
"telephone_number": "810-342-1000",
"fax_number": "810-342-1590"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "36500 S GRATIOT AVE",
"address_2": "STE. 101",
"city": "CLINTON TOWNSHIP",
"state": "MI",
"postal_code": "480351772",
"telephone_number": "586-493-3732",
"fax_number": "586-493-3739"
}
],
"practiceLocations": [],
"basic": {
"last_name": "OLSON",
"first_name": "LUCILA",
"middle_name": "W.",
"name_prefix": "Dr.",
"credential": "M.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2006-05-05",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208000000X",
"taxonomy_group": "",
"desc": "Pediatrics",
"state": "MI",
"license": "4301058057",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3225102",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BCBS BCN COMM BLUE",
"identifier": "350D410030",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "3225096",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4956934",
"state": "MI"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MHP HAN",
"identifier": "1022817",
"state": "MI"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "4682809",
"state": "MI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clinton Township, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 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.