Provider Demographics
NPI:1306259627
Name:BRUSHABER, OLGA (DO)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:BRUSHABER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:KLYUCHNIKOVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:23133 ORCHARD LAKE RD STE 200
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48336-3279
Mailing Address - Country:US
Mailing Address - Phone:248-471-8950
Mailing Address - Fax:248-471-9978
Practice Address - Street 1:23133 ORCHARD LAKE RD STE 200
Practice Address - Street 2:
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48336-3279
Practice Address - Country:US
Practice Address - Phone:248-471-8950
Practice Address - Fax:248-471-9978
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-04
Last Update Date:2020-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101021269207R00000X, 207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5101021269OtherMI LICENSE