Provider Demographics
NPI:1134689649
Name:OLSEN, BENJAMIN ANDREW (MD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:ANDREW
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13001 E 17TH PL
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:CO
Mailing Address - Zip Code:80045-2581
Mailing Address - Country:US
Mailing Address - Phone:720-777-3846
Mailing Address - Fax:
Practice Address - Street 1:13001 E. 17TH PLACE
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80045-2841
Practice Address - Country:US
Practice Address - Phone:720-777-3846
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-03-21
Last Update Date:2022-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR.0068514390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program