Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207XS0106X | Orthopaedic Hand Surgeon | 19198 | WI |
NPI | 1073514790 |
---|---|
Provider Name | David W Olson |
First Address | Milwaukee, WI 53226-1409 |
Second Address | Milwaukee, WI 53226-1409 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2005 |
Last Update Date | 28/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
30295100 | (05) | WI |
B55486 | (02) |