Provider Demographics
NPI:1457328502
Name:OLSON, WILLIAM E (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:E
Last Name:OLSON
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 1:3400 DEXTER CT
Mailing Address - Street 2:SUITE 118
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-344-8333
Mailing Address - Fax:563-344-8334
Practice Address - Street 1:3400 DEXTER CT
Practice Address - Street 2:SUITE 118
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3461
Practice Address - Country:US
Practice Address - Phone:563-344-8333
Practice Address - Fax:563-344-8334
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-07
Last Update Date:2014-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036109035208600000X
IA36204208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA03396OtherBCBS IA #
IL036109035Medicaid
IA1891740882OtherMMSA NPI #
IL08132142OtherBCBS IL #
IL1891740882OtherMMSA NPI #
IA1457328502Medicaid
IAI20345Medicare PIN
IA03396OtherBCBS IA #
ILI32528Medicare UPIN
ILK38345Medicare PIN
IA719260337Medicare PIN