MEDICARE: DR. JOHN N OLSOFKA M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208600000X	Surgery Physician	31325	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	020041621	OTHER	KY	RAILROAD MEDICARE
3	P01026552	OTHER	KY	MEDICARE RR

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1101115	OTHER	KY	PASSPORT
4	000000050008	OTHER	KY	ANTHEM
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1013919273
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOHN N OLSOFKA M.D.

Provider Business Mailing Address
First Line	:	100 E LIBERTY ST
Second Line	:	SUITE 800
City	:	LOUISVILLE
State	:	KY
Zip	:	40202-1434
Country	:	US
Telephone Number	:	502-366-1090
Fax Number	:	502-366-1564

Provider Business Practice Location Address
First Line	:	4402 CHURCHMAN AVE
Second Line	:	STE 202
City	:	LOUISVILLE
State	:	KY
Zip	:	40215-3101
Country	:	US
Telephone Number	:	502-366-1090
Fax Number	:	502-366-1564

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/01/2005
Last Update Date	:	01/23/2019

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Directions to “ DR. JOHN N OLSOFKA M.D.” Practice Location

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