Provider Demographics
NPI:1871553313
Name:BAUER-OLSON, CHERYL K (DO)
Entity type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:K
Last Name:BAUER-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 1:2413 E COUNTRY CLUB DR S
Mailing Address - Street 2:
Mailing Address - City:FARGO
Mailing Address - State:ND
Mailing Address - Zip Code:58103-5730
Mailing Address - Country:US
Mailing Address - Phone:701-429-4385
Mailing Address - Fax:
Practice Address - Street 1:4133 30TH AVE S STE 103
Practice Address - Street 2:
Practice Address - City:FARGO
Practice Address - State:ND
Practice Address - Zip Code:58104-8421
Practice Address - Country:US
Practice Address - Phone:701-499-4847
Practice Address - Fax:701-433-1882
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-27
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA3656207Q00000X
MN50211207Q00000X
ND10745207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN1871553313Medicaid
IA0477406Medicaid
ND14436Medicaid
ND1871553313OtherNDBS
ND1457451Medicaid
MN080016287Medicare PIN
NDN713540Medicare PIN
NDN716368Medicare PIN