Provider Demographics
NPI:1942351168
Name:OLSON, ROBERT A (MD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:A
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 1:3501 DOUGLAS DR N
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2415
Mailing Address - Country:US
Mailing Address - Phone:763-535-9601
Mailing Address - Fax:763-535-5601
Practice Address - Street 1:3501 DOUGLAS DR N
Practice Address - Street 2:
Practice Address - City:CRYSTAL
Practice Address - State:MN
Practice Address - Zip Code:55422-2415
Practice Address - Country:US
Practice Address - Phone:763-535-9601
Practice Address - Fax:763-535-5601
Is Sole Proprietor?:No
Enumeration Date:2007-01-15
Last Update Date:2024-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN17554207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN0056900OtherPREFERRED ONE
MN54B410OLOtherBLUES
MN110119OtherUCARE
MN0714657OtherMEDICA
MNA95568Medicare UPIN