Provider Demographics
NPI:1891062592
Name:OLSON, MICHAEL (DO, MBA)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:
Last Name:OLSON
Suffix:
Gender:M
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:395 W 12TH AVE
Mailing Address - Street 2:SUITE 401
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43210-1267
Mailing Address - Country:US
Mailing Address - Phone:614-293-3494
Mailing Address - Fax:614-293-6935
Practice Address - Street 1:395 W 12TH AVE
Practice Address - Street 2:SUITE 401
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43210-1267
Practice Address - Country:US
Practice Address - Phone:614-293-3494
Practice Address - Fax:614-293-6935
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-23
Last Update Date:2013-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34.0104752085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology