Provider Demographics
NPI:1194801837
Name:OLDEN, MICHAEL PAUL (HT,OST,C-PED,PMAC)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:PAUL
Last Name:OLDEN
Suffix:
Gender:M
Credentials:HT,OST,C-PED,PMAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:404 CIRCLE AVE
Mailing Address - Street 2:
Mailing Address - City:KERRVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78028-4122
Mailing Address - Country:US
Mailing Address - Phone:830-896-0442
Mailing Address - Fax:
Practice Address - Street 1:3600 MEMORIAL BLVD # 11C
Practice Address - Street 2:
Practice Address - City:KERRVILLE
Practice Address - State:TX
Practice Address - Zip Code:78028-5768
Practice Address - Country:US
Practice Address - Phone:830-792-2660
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-27
Last Update Date:2007-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
No174400000XOther Service ProvidersSpecialist
No211D00000XPodiatric Medicine & Surgery Service ProvidersAssistant, Podiatric
No246Y00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Health Information
No247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX2348OtherCERTIFIED PEDORTHIST