Basic Information
| Provider Information | |||||||||
| NPI: | 1891062592 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | OLSON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | D.O., M.B.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 395 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933494 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Practice Location | |||||||||
| Address1: | 395 W 12TH AVE | ||||||||
| Address2: | SUITE 401 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432101267 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6142933494 | ||||||||
| FaxNumber: | 6142936935 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2011 | ||||||||
| LastUpdateDate: | 01/17/2013 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | 34.010475 | OH | Y | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology |
No ID Information.