Provider Demographics
NPI:1568616068
Name:OLSON, CARRIE LUTZ (MD)
Entity Type:Individual
Prefix:DR
First Name:CARRIE
Middle Name:LUTZ
Last Name:OLSON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:DR
Other - First Name:CARRIE
Other - Middle Name:ANN
Other - Last Name:LUTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:ST. ELIZABETH PHYSICIANS
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-301-5650
Mailing Address - Fax:859-301-6050
Practice Address - Street 1:2845 CHANCELLOR DR
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017
Practice Address - Country:US
Practice Address - Phone:859-301-5605
Practice Address - Fax:859-301-6050
Is Sole Proprietor?:No
Enumeration Date:2008-11-11
Last Update Date:2018-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY34232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2269727Medicaid
KY64014475Medicaid
H24357Medicare UPIN
KY00954017Medicare PIN
OH2269727Medicaid