Provider Demographics
NPI:1831174341
Name:OLSON, KURT (MD)
Entity type:Individual
Prefix:
First Name:KURT
Middle Name:
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 1:512 AMHERST DR SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87106-1502
Mailing Address - Country:US
Mailing Address - Phone:505-582-2478
Mailing Address - Fax:505-923-5354
Practice Address - Street 1:512 AMHERST DR SE
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87106-1502
Practice Address - Country:US
Practice Address - Phone:505-582-2478
Practice Address - Fax:505-923-5354
Is Sole Proprietor?:No
Enumeration Date:2005-12-07
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM822762084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM22608Medicaid
$$$$$$$$$PMedicare PIN
NM22608Medicaid