Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | 37478 | MN |
Y | 111NI0900X | Internist | 37478 | MN |
N | 207RC0200X | Critical Care Medicine | 1033179429 | MN |
NPI | 1033179429 |
---|---|
Provider Name | Kenneth David Olsen |
First Address | Minneapolis, MN 55407-1321 |
Second Address | Minneapolis, MN 55407-1321 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/03/2006 |
Last Update Date | 10/11/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
409525100 | (05) | MN |
G46568 | (02) |