Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0200X | Critical Care Medicine | 33316 | MN |
NPI | 1063402725 |
---|---|
Provider Name | John D Olsen |
First Address | Saint Cloud, MN 56303-2735 |
Second Address | Saint Cloud, MN 56303-2735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2005 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
109311 | U-CARE (01) | |
2114091 | FIRST HEALTH PLAN (01) | |
4829223 | MEDICA HEALTH PLANS (01) | |
596783 | ARAZ GRP/AMERICA'S PPO (01) | |
6D081OL | BLUE CROSS BLUE SHIELD (01) | |
986022 | PREFERRED ONE (01) | |
E68159 | (02) | |
HP25499 | HEALTH PARTNERS (01) |