Provider Demographics
NPI:1609996131
Name:OLSON, CAROLINE E (MD)
Entity Type:Individual
Prefix:DR
First Name:CAROLINE
Middle Name:E
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 1:2260 W HIGGINS RD
Mailing Address - Street 2:SUITE #103
Mailing Address - City:HOFFMAN ESTATES
Mailing Address - State:IL
Mailing Address - Zip Code:60195-2431
Mailing Address - Country:US
Mailing Address - Phone:847-519-9103
Mailing Address - Fax:847-519-9107
Practice Address - Street 1:2260 W HIGGINS RD
Practice Address - Street 2:SUITE #103
Practice Address - City:HOFFMAN ESTATES
Practice Address - State:IL
Practice Address - Zip Code:60195-2431
Practice Address - Country:US
Practice Address - Phone:847-519-9103
Practice Address - Fax:847-519-9107
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC43974Medicare UPIN
IL483 730Medicare ID - Type Unspecified