MEDICARE: JENNIFER ELIZABETH 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
1	207R00000X	Internal Medicine Physician	35.099622	OH
2	207R00000X	Internal Medicine Physician	036112437	IL
3	207R00000X	Internal Medicine Physician	01078252A	IN

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	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1932202991
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JENNIFER ELIZABETH OLSON MD

Provider Business Mailing Address
First Line	:	1100 REID PARKWAY
Second Line	:	MEDICAL STAFF SVCS.
City	:	RICHMOND
State	:	IN
Zip	:	47374-1157
Country	:	US
Telephone Number	:	765-935-4088
Fax Number	:	765-966-2596

Provider Business Practice Location Address
First Line	:	1471 CHESTER BLVD.
Second Line	:	STE. A, REID INTERNAL MEDICINE
City	:	RICHMOND
State	:	IN
Zip	:	47374-1946
Country	:	US
Telephone Number	:	765-935-4088
Fax Number	:	765-966-2596

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

Provider Enumeration Date	:	09/06/2006
Last Update Date	:	05/18/2021

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