John Joseph Olesnavage, PH.D.
Individual provider Active NPI Psychologist · Big Bay, MI
NPI 1942237672 · NPPES record last updated Jul 7, 2009
Key facts
- NPI
- 1942237672
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Psychologist 103T00000X
- License
- 6301010173 (MI)
- Practice address
- 3926 Squaw Beach Road
Big Bay, MI 49808-0254 - Phone
- (906) 250-4799
- NPI assigned
- Jun 27, 2006
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6301010173 | MI | MD | Psychologist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Olesnavage Psychological Services PC | Psychologist | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Psychologist | 103T00000X | 6301010173 | MI | Yes |
Addresses
Primary practice location
3926 Squaw Beach Road
Big Bay, MI 49808-0254
Mailing address
3926 Squaw Beach Road
P O Box 254
Big Bay, MI 49808-0254
Phone (906) 250-4799
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 237649000 | Other | MI | MAGELLAN HEALTH |
| 680E210290 | Other | MI | BCBSM PIN NUMBER |
Other providers in Big Bay, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 7, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.