Provider Demographics
NPI:1922008044
Name:OLSON, ROSS STANLEY (MD)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:STANLEY
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 1:5512 14TH AVE S
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55417-2531
Mailing Address - Country:US
Mailing Address - Phone:612-824-7691
Mailing Address - Fax:651-455-2012
Practice Address - Street 1:5975 CARMEN AVE
Practice Address - Street 2:
Practice Address - City:INVER GROVE HEIGHTS
Practice Address - State:MN
Practice Address - Zip Code:55076-4416
Practice Address - Country:US
Practice Address - Phone:651-455-9697
Practice Address - Fax:651-455-2012
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN18224174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist