Basic Information
| Provider Information | |||||||||
| NPI: | 1649219908 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | FREDERICK | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Practice Location | |||||||||
| Address1: | 1221 NICOLLET AVE | ||||||||
| Address2: | SUITE 600 | ||||||||
| City: | MINNEAPOLIS | ||||||||
| State: | MN | ||||||||
| PostalCode: | 554032420 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6125732232 | ||||||||
| FaxNumber: | 6125732274 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/05/2006 | ||||||||
| LastUpdateDate: | 05/01/2009 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 23771 | MN | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
ID Information
| ID | Type | State | Issuer | Description | 0984674 | 05 | IA | MEDICAID | 22998 | 01 | MN | AMERICA'S PPO | OTHER | 0247011 | 01 | MN | PREFERRED ONE | OTHER | 12973OL | 01 | MN | BLUE CROSS | OTHER | 802307700 | 05 | MN | MEDICAID | HP14104 | 01 | MN | HEALTHPARTNERS | OTHER | 0178703 | 01 | MN | DEPT OF LABOR & INDUSTRIE | OTHER | 30227500 | 05 | WI | MEDICAID | 100703 | 01 | MN | UCARE | OTHER | 300065116 | 01 | MN | RAILROAD MEDICARE MN | OTHER | 3000011425 | 01 | WI | RAILROAD MEDICARE WI | OTHER | 301G3OL | 01 | MN | BLUE CROSS | OTHER |