Healthcare Provider Details

I. General information

NPI: 1346474111
Provider Name (Legal Business Name): SHAWN MICHAEL OLSON MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/08/2009
Last Update Date: 03/10/2026
Certification Date: 03/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2855 ANTHONY LN S STE 140
ST ANTHONY MN
55418-2880
US

IV. Provider business mailing address

2855 ANTHONY LN S STE 140
ST ANTHONY MN
55418-2880
US

V. Phone/Fax

Practice location:
  • Phone: 612-234-5566
  • Fax: 612-500-4577
Mailing address:
  • Phone: 612-217-4834
  • Fax: 612-500-4577

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number56398
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number56398
License Number StateMN
# 3
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License Number56398
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: