MEDICARE: JEFFREY A. 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	207R00000X	Internal Medicine Physician	A75543	CA
2	207R00000X	Internal Medicine Physician	0000	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	036.110640	OTHER	IL	STATE LICENSE
2	336.071295	OTHER	IL	CDS LIC

General Provider Information

NPI Number	:	1952374795
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JEFFREY A. OLSON M.D,

Provider Business Mailing Address
First Line	:	2740 W FOSTER AVE
Second Line	:	LL7
City	:	CHICAGO
State	:	IL
Zip	:	60625
Country	:	US
Telephone Number	:	773-878-8200
Fax Number	:	773-293-4197

Provider Business Practice Location Address
First Line	:	5215 N CALIFORNIA AVE
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60625-7014
Country	:	US
Telephone Number	:	773-878-3627
Fax Number	:	773-275-5860

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

Provider Enumeration Date	:	02/10/2006
Last Update Date	:	03/07/2023

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Directions to “ JEFFREY A. OLSON M.D,” Practice Location

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