Provider Demographics
NPI:1265480297
Name:OLSON, KRISTI RAE (MD)
Entity Type:Individual
Prefix:DR
First Name:KRISTI
Middle Name:RAE
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1711 S STEPHENSON AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:IRON MOUNTAIN
Mailing Address - State:MI
Mailing Address - Zip Code:49801-3650
Mailing Address - Country:US
Mailing Address - Phone:906-774-1633
Mailing Address - Fax:906-774-4451
Practice Address - Street 1:1711 S STEPHENSON AVE STE 300
Practice Address - Street 2:
Practice Address - City:IRON MOUNTAIN
Practice Address - State:MI
Practice Address - Zip Code:49801-3650
Practice Address - Country:US
Practice Address - Phone:906-774-1633
Practice Address - Fax:906-774-4451
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301087107207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4890529Medicaid
MIP00362792OtherRAILROAD MEDICARE
WI34877900Medicaid
MIP00362792OtherRAILROAD MEDICARE
WI34877900Medicaid
MI4890529Medicaid