Healthcare Provider Details

I. General information

NPI: 1134396179
Provider Name (Legal Business Name): BJORN THOMAS OLSEN M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2008
Last Update Date: 07/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 ROSE ST # N212
LEXINGTON KY
40536-2263
US

IV. Provider business mailing address

800 ROSE STREET, N217
LEXINGTON KY
40536-2263
US

V. Phone/Fax

Practice location:
  • Phone: 859-323-5956
  • Fax: 859-323-1080
Mailing address:
  • Phone: 859-323-5956
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number45082
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code207LC0200X
TaxonomyCritical Care Medicine (Anesthesiology) Physician
License Number45082
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: