MEDICARE: SUE ANN OLMSTEAD DO

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	2336	IA

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

General Provider Information

NPI Number	:	1760442768
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUE ANN OLMSTEAD DO

Provider Business Mailing Address
First Line	:	6400 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-5001
Country	:	US
Telephone Number	:	515-274-3551
Fax Number	:	515-274-3512

Provider Business Practice Location Address
First Line	:	6400 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-5001
Country	:	US
Telephone Number	:	515-274-3551
Fax Number	:	515-274-3512

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

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	10/30/2020

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Directions to “ SUE ANN OLMSTEAD DO” Practice Location

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