Provider Demographics
NPI:1629287834
Name:OLSON PAIN & STRESS MANAGEMENT ASSOCIATES INC.
Entity Type:Organization
Organization Name:OLSON PAIN & STRESS MANAGEMENT ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:ELAINE
Authorized Official - Middle Name:E
Authorized Official - Last Name:OLSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-793-8890
Mailing Address - Street 1:PO BOX 1226
Mailing Address - Street 2:
Mailing Address - City:PARK RIDGE
Mailing Address - State:IL
Mailing Address - Zip Code:60068-7226
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:LINCOLNSHIRE
Practice Address - State:IL
Practice Address - Zip Code:60069-3095
Practice Address - Country:US
Practice Address - Phone:847-793-8890
Practice Address - Fax:847-793-8842
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2008-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036069815174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036069815Medicaid
ILL62349OtherMC PIN#
IL21621708OtherBLUE CROSS BLUESHIELD
ILD16146Medicare UPIN
IL400020Medicare ID - Type UnspecifiedMEDICARE PAY TO