MEDICARE: MARYPAT OLSETH ANDERSON 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	207Q00000X	Family Medicine Physician	38776	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	564R5AN	OTHER	MN	BCBS
2	01-18458	OTHER	MN	MEDICA
3	120311	OTHER	MN	UCARE

General Provider Information

NPI Number	:	1184606667
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARYPAT OLSETH ANDERSON M.D.

Provider Business Mailing Address
First Line	:	600 MAYWOOD AVE
Second Line	:	21 CARKOSKI COMMONS
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-278-3858
Fax Number	:

Provider Business Practice Location Address
First Line	:	600 MAYWOOD AVE
Second Line	:	21 CARKOSKI COMMONS
City	:	MANKATO
State	:	MN
Zip	:	56001-7008
Country	:	US
Telephone Number	:	507-389-6276
Fax Number	:	507-389-5787

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

Provider Enumeration Date	:	11/18/2005
Last Update Date	:	01/27/2022

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