Provider Demographics
NPI:1184685844
Name:OLSON, PAUL LEWIS (MD)
Entity Type:Individual
Prefix:DR
First Name:PAUL
Middle Name:LEWIS
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:7907 POWERS BLVD
Mailing Address - Street 2:
Mailing Address - City:CHANHASSEN
Mailing Address - State:MN
Mailing Address - Zip Code:55317-9502
Mailing Address - Country:US
Mailing Address - Phone:952-934-0570
Mailing Address - Fax:952-906-7837
Practice Address - Street 1:7907 POWERS BLVD
Practice Address - Street 2:
Practice Address - City:CHANHASSEN
Practice Address - State:MN
Practice Address - Zip Code:55317-9502
Practice Address - Country:US
Practice Address - Phone:952-934-0570
Practice Address - Fax:952-906-7837
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2011-06-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN27363207RN0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN586268000Medicaid
MN586268000Medicaid