Provider Demographics
NPI:1588234066
Name:DR. BAUER-OLSON, FAMILY DOCTOR, PLLC
Entity Type:Organization
Organization Name:DR. BAUER-OLSON, FAMILY DOCTOR, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHERYL
Authorized Official - Middle Name:K
Authorized Official - Last Name:BAUER-OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:701-499-4847
Mailing Address - Street 1:2413 E COUNTRY CLUB DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5730
Mailing Address - Country:US
Mailing Address - Phone:701-429-4385
Mailing Address - Fax:
Practice Address - Street 1:4133 30TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8421
Practice Address - Country:US
Practice Address - Phone:701-499-4847
Practice Address - Fax:701-433-1882
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND14436Medicaid
ND1484174Medicaid
MN4754236OtherBCBSMN
ND1588234066OtherNDBS
MN1588234066Medicaid