Provider Demographics
NPI:1013919273
Name:OLSOFKA, JOHN N (MD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:N
Last Name:OLSOFKA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-366-1090
Mailing Address - Fax:502-366-1564
Practice Address - Street 1:4402 CHURCHMAN AVE
Practice Address - Street 2:STE 202
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-3101
Practice Address - Country:US
Practice Address - Phone:502-366-1090
Practice Address - Fax:502-366-1564
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2019-01-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
KY31325208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY1101115OtherPASSPORT
KY020041621OtherRAILROAD MEDICARE
KYP01026552OtherMEDICARE RR
KY000000050008OtherANTHEM
KY64313257Medicaid
KY000000050008OtherANTHEM
KYG44796Medicare UPIN
KYK029970Medicare Oscar/Certification
IN228550009Medicare PIN