Provider Demographics
NPI:1861496366
Name:OLSON, ERIK K (MD)
Entity Type:Individual
Prefix:DR
First Name:ERIK
Middle Name:K
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:PO BOX 8
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0008
Mailing Address - Country:US
Mailing Address - Phone:800-476-8646
Mailing Address - Fax:
Practice Address - Street 1:727 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:SHELBYVILLE
Practice Address - State:KY
Practice Address - Zip Code:40065-1660
Practice Address - Country:US
Practice Address - Phone:502-647-4347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38906207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50005993OtherPASSPORT GROUP # 1172544
KY64089808Medicaid
KY000000060164Other12 DIGIT BCBS/KY NUMBER
KY000000275811Other12 DIGIT BCBS/KY NUMBER
KY64089808Medicaid
KY50005993OtherPASSPORT GROUP # 1172544
KY0754611Medicare ID - Type UnspecifiedMEDICARE GROUP # 7546