MEDICARE: MR. ROSS STANLEY OLSON 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	174400000X	Specialist	18224	MN

General Provider Information

NPI Number	:	1922008044
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ROSS STANLEY OLSON M.D.

Provider Business Mailing Address
First Line	:	5512 14TH AVE S
Second Line	:
City	:	MINNEAPOLIS
State	:	MN
Zip	:	55417-2531
Country	:	US
Telephone Number	:	612-824-7691
Fax Number	:	651-455-2012

Provider Business Practice Location Address
First Line	:	5975 CARMEN AVE
Second Line	:
City	:	INVER GROVE HEIGHTS
State	:	MN
Zip	:	55076-4416
Country	:	US
Telephone Number	:	651-455-9697
Fax Number	:	651-455-2012

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

Provider Enumeration Date	:	07/29/2005
Last Update Date	:	07/08/2007

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