Provider Demographics
NPI:1104805449
Name:OLSHOCK, RICHARD C (MD)
Entity type:Individual
Prefix:DR
First Name:RICHARD
Middle Name:C
Last Name:OLSHOCK
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:14275 MIDWAY RD
Mailing Address - Street 2:SUITE 400
Mailing Address - City:ADDISON
Mailing Address - State:TX
Mailing Address - Zip Code:75001-3614
Mailing Address - Country:US
Mailing Address - Phone:214-932-8029
Mailing Address - Fax:610-271-4245
Practice Address - Street 1:6750 W 52ND AVE
Practice Address - Street 2:SUITE F
Practice Address - City:ARVADA
Practice Address - State:CO
Practice Address - Zip Code:80002-3956
Practice Address - Country:US
Practice Address - Phone:720-898-3300
Practice Address - Fax:720-898-3333
Is Sole Proprietor?:No
Enumeration Date:2006-01-14
Last Update Date:2014-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CODR21801207ZP0105X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0105XAllopathic & Osteopathic PhysiciansPathologyClinical Pathology/Laboratory Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO01218015Medicaid
COCM5118Medicare PIN
CO01218015Medicaid
COM5008Medicare PIN