Provider Demographics
NPI:1447254081
Name:OLSON, JOHN KENNEDY (MD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:KENNEDY
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:855 A AVE NE
Mailing Address - Street 2:P O BOX 3080
Mailing Address - City:CEDAR RAPIDS
Mailing Address - State:IA
Mailing Address - Zip Code:52406-3080
Mailing Address - Country:US
Mailing Address - Phone:319-368-5500
Mailing Address - Fax:319-368-5503
Practice Address - Street 1:701 10TH ST SE
Practice Address - Street 2:J EDWARD LUNDY PAVILLION 4TH FLOOR
Practice Address - City:CEDAR RAPIDS
Practice Address - State:IA
Practice Address - Zip Code:52403-1251
Practice Address - Country:US
Practice Address - Phone:319-221-8400
Practice Address - Fax:319-221-8403
Is Sole Proprietor?:No
Enumeration Date:2005-06-10
Last Update Date:2011-11-28
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Provider Licenses
StateLicense IDTaxonomies
IA31645207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAG64456Medicare UPIN