Provider Demographics
NPI:1265422448
Name:OLSON, CHRISTOPHER G (MD)
Entity type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:G
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 1:1220 HOBSON RD
Mailing Address - Street 2:STE 116
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60540-8137
Mailing Address - Country:US
Mailing Address - Phone:630-416-3300
Mailing Address - Fax:630-646-5648
Practice Address - Street 1:1220 HOBSON RD
Practice Address - Street 2:SUITE 116
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60540-8137
Practice Address - Country:US
Practice Address - Phone:630-416-3300
Practice Address - Fax:630-646-5648
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036077237207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL036077237 5Medicaid
IL160037489Medicare PIN
IL160050502Medicare PIN
ILL58034Medicare PIN
IL036077237 5Medicaid
ILL58035Medicare PIN
F21565Medicare UPIN