Healthcare Provider Details

I. General information

NPI: 1013919273
Provider Name (Legal Business Name): JOHN N OLSOFKA M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2005
Last Update Date: 01/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4402 CHURCHMAN AVE STE 202
LOUISVILLE KY
40215-3101
US

IV. Provider business mailing address

100 E LIBERTY ST SUITE 800
LOUISVILLE KY
40202-1434
US

V. Phone/Fax

Practice location:
  • Phone: 502-366-1090
  • Fax: 502-366-1564
Mailing address:
  • Phone: 502-366-1090
  • Fax: 502-366-1564

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number31325
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: