Provider Demographics
NPI:1487679759
Name:OLSON, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
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 1:4013 N. RIDGE RD. STE 210
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205
Mailing Address - Country:US
Mailing Address - Phone:316-945-7309
Mailing Address - Fax:316-945-9131
Practice Address - Street 1:4013 N RIDGE RD
Practice Address - Street 2:STE. 210
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-8857
Practice Address - Country:US
Practice Address - Phone:316-945-7309
Practice Address - Fax:316-945-9131
Is Sole Proprietor?:No
Enumeration Date:2006-07-13
Last Update Date:2015-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-28897208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100402670AMedicaid
KSG19844Medicare UPIN
G19844Medicare UPIN
KS100402670AMedicaid