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General NPI Number Information
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NPI Number | 1952374795
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Entity Type | Individual
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Provider Name | JEFFREY A. OLSON M.D,
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Gender | Male
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Dates
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Enumeration Date | 02/10/2006
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 5215 N CALIFORNIA AVE
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City | CHICAGO
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State | IL
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Zip | 60625-7014
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Country | US
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Telephone | 773-878-3627
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Fax | 773-275-5860
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Provider Business Mailing Address
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Address Line | 2740 W FOSTER AVE LL7
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City | CHICAGO
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State | IL
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Zip | 60625
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Country | US
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Telephone | 773-878-8200
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Fax | 773-293-4197
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A75543
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 0000
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License Number State | IL
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