Healthcare Provider Details

I. General information

NPI: 1184685844
Provider Name (Legal Business Name): PAUL LEWIS OLSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 06/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7907 POWERS BLVD
CHANHASSEN MN
55317-9502
US

IV. Provider business mailing address

7907 POWERS BLVD
CHANHASSEN MN
55317-9502
US

V. Phone/Fax

Practice location:
  • Phone: 952-934-0570
  • Fax: 952-906-7837
Mailing address:
  • Phone: 952-934-0570
  • Fax: 952-906-7837

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RN0300X
TaxonomyNephrology Physician
License Number27363
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: