Provider Demographics
NPI:1245213164
Name:OLSAN, ADAM D (MD)
Entity Type:Individual
Prefix:
First Name:ADAM
Middle Name:D
Last Name:OLSAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1800 RYAN ST
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70601-6078
Mailing Address - Country:US
Mailing Address - Phone:337-439-4706
Mailing Address - Fax:337-439-8110
Practice Address - Street 1:1800 RYAN ST
Practice Address - Street 2:SUITE 105
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70601-6078
Practice Address - Country:US
Practice Address - Phone:337-439-4706
Practice Address - Fax:337-439-8110
Is Sole Proprietor?:No
Enumeration Date:2005-11-23
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
LA0252822085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1577511Medicaid
LA32344OtherCDS
P00230279OtherRAILROAD MEDICARE
LABO7446873OtherDEA
LABO7446873OtherDEA
I25252Medicare UPIN