Provider Demographics
NPI:1619963311
Name:OLSON, ELAINE ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:ELAINE
Middle Name:ELIZABETH
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:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068
Mailing Address - Country:US
Mailing Address - Phone:847-793-8890
Mailing Address - Fax:847-793-8892
Practice Address - Street 1:100 VILLAGE GREEN DR
Practice Address - Street 2:#220
Practice Address - City:LINCOLNSHINE
Practice Address - State:IL
Practice Address - Zip Code:60069-3095
Practice Address - Country:US
Practice Address - Phone:847-793-8890
Practice Address - Fax:847-793-8894
Is Sole Proprietor?:No
Enumeration Date:2005-09-27
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL21621708OtherBLUECROSS BS
IL21621708OtherBCBS
DC400020Medicare ID - Type Unspecified
ILLC2349Medicare PIN
IL400020Medicare Oscar/Certification
IL21621708OtherBCBS