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NPI Code Detail

MEDICARE: KENNETH OLSON MD

MEDICARE: KENNETH OLSON MD
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
1207Q00000XFamily Medicine Physician22223MN

General Provider Information

NPI Number : 1336126275
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH OLSON MD
Provider Business Mailing Address
First Line : 7801 E BUSH LAKE RD STE 400
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55439-3113
Country : US
Telephone Number : 952-283-3162
Fax Number : 866-991-7241
Provider Business Practice Location Address
First Line : 7801 E BUSH LAKE RD STE 400
Second Line :
City : MINNEAPOLIS
State : MN
Zip : 55439-3113
Country : US
Telephone Number : 952-283-3162
Fax Number : 866-991-7241
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/30/2005
Last Update Date : 02/28/2020

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Directions to “ KENNETH OLSON MD” Practice Location

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