Healthcare Provider Details

I. General information

NPI: 1356415426
Provider Name (Legal Business Name): AXEL KENNETH OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 02/01/2022
Certification Date: 02/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3686 GRANDVIEW PKWY STE 750
BIRMINGHAM AL
35243
US

IV. Provider business mailing address

3686 GRANDVIEW PKWY STE 750
BIRMINGHAM AL
35243-3409
US

V. Phone/Fax

Practice location:
  • Phone: 205-536-7600
  • Fax: 205-203-4491
Mailing address:
  • Phone: 205-536-7600
  • Fax: 205-203-4491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number13077
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: