Provider Demographics
NPI:1649219908
Name:OLSON, FREDERICK R (MD)
Entity Type:Individual
Prefix:
First Name:FREDERICK
Middle Name:R
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 NICOLLET AVE
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55403-2420
Mailing Address - Country:US
Mailing Address - Phone:612-573-2232
Mailing Address - Fax:612-573-2274
Practice Address - Street 1:1221 NICOLLET AVE
Practice Address - Street 2:SUITE 600
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55403-2420
Practice Address - Country:US
Practice Address - Phone:612-573-2232
Practice Address - Fax:612-573-2274
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2009-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN237712085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0984674Medicaid
MN22998OtherAMERICA'S PPO
MN0247011OtherPREFERRED ONE
MN12973OLOtherBLUE CROSS
MN802307700Medicaid
MNHP14104OtherHEALTHPARTNERS
MN0178703OtherDEPT OF LABOR & INDUSTRIE
WI30227500Medicaid
MN100703OtherUCARE
MN300065116OtherRAILROAD MEDICARE MN
WI3000011425OtherRAILROAD MEDICARE WI
MN301G3OLOtherBLUE CROSS
MN300000087Medicare PIN
MN301G3OLOtherBLUE CROSS
MNHP14104OtherHEALTHPARTNERS
MN802307700Medicaid
MN300002934Medicare PIN
WI30227500Medicaid