Provider Demographics
NPI:1033441548
Name:KLAHM, OLGA (PA-C)
Entity type:Individual
Prefix:
First Name:OLGA
Middle Name:
Last Name:KLAHM
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:OLGA
Other - Middle Name:
Other - Last Name:PETROVIC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:29275 NORTHWESTERN HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48034-5700
Mailing Address - Country:US
Mailing Address - Phone:248-784-3667
Mailing Address - Fax:248-869-3982
Practice Address - Street 1:3555 W 13 MILE RD STE N220
Practice Address - Street 2:
Practice Address - City:ROYAL OAK
Practice Address - State:MI
Practice Address - Zip Code:48073-6710
Practice Address - Country:US
Practice Address - Phone:248-784-3667
Practice Address - Fax:248-869-3982
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-08
Last Update Date:2024-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5601005698363A00000X
FL9105160363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant