Healthcare Provider Details

I. General information

NPI: 1871848812
Provider Name (Legal Business Name): JOHN JOSEPH OLSHEFSKI M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 12/02/2024
Certification Date: 12/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2630 CENTRAL AVE BLDG 3349
EIELSON AFB AK
99702-2301
US

IV. Provider business mailing address

2630 CENTRAL AVE BLDG 3349
EIELSON AFB AK
99702-2301
US

V. Phone/Fax

Practice location:
  • Phone: 73-773-6419
  • Fax:
Mailing address:
  • Phone: 73-773-6419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number27618
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: