Johansen, Olaf B

Johansen, Olaf B is an individual health care provider with primary practice located at 1215 Hadley Rd Ste 201, Mooresville IN 46158-2905. He recently has 2 registered licenses in different health care specialties including Other Service Providers / Specialist, Allopathic & Osteopathic Physicians / Colon & Rectal Surgery. Allopathic & Osteopathic Physicians / Colon & Rectal Surgery is his primary health care specialty. Johansen, Olaf B can be contacted via phone (317) 834-2020.

Contact Information

Primary practice address
1215 Hadley Rd Ste 201 Mooresville IN 46158-2905
Phone: (317) 834-2020
Fax: (317) 831-9292
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Other Service Providers / Specialist 174400000X 01040001A Indiana
Allopathic & Osteopathic Physicians / Colon & Rectal Surgery 208C00000X 01040001A Indiana

Profile Details

NPI number 1942202015
LBN Legal business name Johansen, Olaf B
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 2nd, 2005
Last updated Mar 21st, 2013 - about 12 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1942202015 NPPES
Indiana MEDICAID 200008930A
Indiana Other 000000091932

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