Healthcare Provider Details

I. General information

NPI: 1225032147
Provider Name (Legal Business Name): BRAD A OLSON M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 10/10/2025
Certification Date: 10/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

115 S REYNOLDS RD
TOLEDO OH
43615-6958
US

IV. Provider business mailing address

708 BRIDGEVIEW DR
PERRYSBURG OH
43551-3900
US

V. Phone/Fax

Practice location:
  • Phone: 419-725-6631
  • Fax:
Mailing address:
  • Phone: 567-702-1090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RA0401X
TaxonomyAddiction Medicine (Internal Medicine) Physician
License Number35074948
License Number StateOH
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberOH35074948O
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: