Provider Demographics
NPI:1245679802
Name:OLSEN, ANSGAR STEVEN (DPM)
Entity type:Individual
Prefix:DR
First Name:ANSGAR
Middle Name:STEVEN
Last Name:OLSEN
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7551 CHRISLAND CV
Mailing Address - Street 2:
Mailing Address - City:FALLS CHURCH
Mailing Address - State:VA
Mailing Address - Zip Code:22042-7563
Mailing Address - Country:US
Mailing Address - Phone:847-445-7748
Mailing Address - Fax:
Practice Address - Street 1:360 PLAZA DR STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-2960
Practice Address - Country:US
Practice Address - Phone:812-372-6274
Practice Address - Fax:812-372-6274
Is Sole Proprietor?:No
Enumeration Date:2013-06-17
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN07001234A213ES0103X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery