Provider Demographics
NPI:1033129002
Name:OLSON, AARON CARROLL (DPM)
Entity Type:Individual
Prefix:
First Name:AARON
Middle Name:CARROLL
Last Name:OLSON
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 N 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-4510
Mailing Address - Country:US
Mailing Address - Phone:701-530-5870
Mailing Address - Fax:701-530-5879
Practice Address - Street 1:525 N 9TH ST
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-4510
Practice Address - Country:US
Practice Address - Phone:701-530-5870
Practice Address - Fax:701-530-5879
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ND7213E00000X
SD150213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND12125Medicaid
SD7760700Medicaid
CS1657OtherRRMC
ND12125Medicaid
CS1657OtherRRMC
NDN4779Medicare PIN