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NPI Code Detail

MEDICARE: DR. BRAD A OLSON M.D.

MEDICARE: DR. BRAD A OLSON M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208000000XPediatrics PhysicianOH35074948OOH
2207RA0401XAddiction Medicine (Internal Medicine) Physician35074948OH

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1000000141665OTHEROHBLUE CROSS BLUE SHIELD PI
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1225032147
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. BRAD A OLSON M.D.
Provider Business Mailing Address
First Line : 708 BRIDGEVIEW DR
Second Line :
City : PERRYSBURG
State : OH
Zip : 43551-3900
Country : US
Telephone Number : 567-702-1090
Fax Number :
Provider Business Practice Location Address
First Line : 115 S REYNOLDS RD
Second Line :
City : TOLEDO
State : OH
Zip : 43615-6958
Country : US
Telephone Number : 419-725-6631
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/09/2005
Last Update Date : 10/10/2025

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