Healthcare Provider Details

I. General information

NPI: 1306537626
Provider Name (Legal Business Name): RYAN MICHAEL OLSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 W MARKET ST
LIMA OH
45801-4602
US

IV. Provider business mailing address

6435 W JEFFERSON BLVD PMB 109
FORT WAYNE IN
46804-6203
US

V. Phone/Fax

Practice location:
  • Phone: 419-227-3361
  • Fax:
Mailing address:
  • Phone: 260-344-4035
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number34.018284
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: