MEDICARE: DR. BAUER-OLSON, FAMILY DOCTOR, PLLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4754236	OTHER	MN	BCBSMN
4	1588234066	OTHER	ND	NDBS
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588234066
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR. BAUER-OLSON, FAMILY DOCTOR, PLLC

Provider Business Mailing Address
First Line	:	2413 E COUNTRY CLUB DR S
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58103-5730
Country	:	US
Telephone Number	:	701-429-4385
Fax Number	:

Provider Business Practice Location Address
First Line	:	4133 30TH AVE S STE 103
Second Line	:
City	:	FARGO
State	:	ND
Zip	:	58104-8421
Country	:	US
Telephone Number	:	701-499-4847
Fax Number	:	701-433-1882

Authorized Official
Title or Position	:	OWNER
Name	:	DR. CHERYL K BAUER-OLSON
Credential	:	DO
Telephone Number	:	701-499-4847

Provider Enumeration Date	:	06/28/2021
Last Update Date	:	05/15/2023

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Directions to “DR. BAUER-OLSON, FAMILY DOCTOR, PLLC ” Practice Location

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