Provider Demographics
NPI:1801846977
Name:OLSETH, MARIE CASEY (MD)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:CASEY
Last Name:OLSETH
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1550 UTICA AVE S
Mailing Address - Street 2:SUITE 450
Mailing Address - City:ST LOUIS PARK
Mailing Address - State:MN
Mailing Address - Zip Code:55416-5312
Mailing Address - Country:US
Mailing Address - Phone:952-856-8452
Mailing Address - Fax:
Practice Address - Street 1:1550 UTICA AVE S
Practice Address - Street 2:SUITE 450
Practice Address - City:ST LOUIS PARK
Practice Address - State:MN
Practice Address - Zip Code:55416-5312
Practice Address - Country:US
Practice Address - Phone:952-856-8452
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2016-08-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MNPY 494972084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN260003014Medicare Oscar/Certification