Provider Demographics
NPI:1396951356
Name:OLSON, LINDSEY MARIE (DO)
Entity type:Individual
Prefix:
First Name:LINDSEY
Middle Name:MARIE
Last Name:OLSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 COLORADO AVE
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1334
Mailing Address - Country:US
Mailing Address - Phone:815-469-2123
Mailing Address - Fax:815-469-2149
Practice Address - Street 1:222 COLORADO AVE
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1334
Practice Address - Country:US
Practice Address - Phone:815-469-2123
Practice Address - Fax:815-469-2149
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2017-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL125051079390200000X
IL036122817207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program