MEDICARE: AGUSTA OLAFSDOTTIR MD

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
1	207RE0101X	Endocrinology, Diabetes & Metabolism Physician	36729	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	27800	OTHER	IA	WELLMARK BCBS

General Provider Information

NPI Number	:	1699888222
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AGUSTA OLAFSDOTTIR MD

Provider Business Mailing Address
First Line	:	621 S NEW BALLAS RD STE 3016B
Second Line	:	MERCY CLINIC ADULT HOSPITALIST
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8267
Country	:	US
Telephone Number	:	314-251-6339
Fax Number	:	314-251-4564

Provider Business Practice Location Address
First Line	:	621 S NEW BALLAS RD STE 3016B
Second Line	:	MERCY CLINIC ADULT HOSPITALIST
City	:	SAINT LOUIS
State	:	MO
Zip	:	63141-8267
Country	:	US
Telephone Number	:	314-251-6339
Fax Number	:	314-251-4564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/17/2006
Last Update Date	:	10/06/2011

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