Provider Demographics
NPI:1245315084
Name:OLSON, STEPHEN C (MD)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:C
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - Street 2:420 DELAWARE STREET SE
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-273-8700
Mailing Address - Fax:
Practice Address - Street 1:2312 S 6TH ST
Practice Address - Street 2:SUITE F256 / 2B WEST
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55454-1336
Practice Address - Country:US
Practice Address - Phone:612-273-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2012-05-30
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN434302084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN15-70912OtherMEDICA CHOICE
MNHP40425OtherHEALTH PARTNERS
IA0537456Medicaid
MN318663600Medicaid
MN160777OtherUCARE
MN15-70912OtherMEDICA PRIMARY
MN1027510OtherPREFERRED ONE
MN1216950OtherARAZ
MN053A4OLOtherBLUE CROSS BLUE SHIELD
MN318663600Medicaid
IA0537456Medicaid