Individual
JOHN LEO OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
1650 S 41ST ST, MANITOWOC, WI 54220-7316
(920) 320-2436
Mailing address
1650 S 41ST ST, MANITOWOC, WI 54220-7316
(920) 320-2436
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
Primary
54385-020
WI
2084P0800X
Psychiatry Physician
67965261205
UT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
54385-020
WI DRL
WI
01
—
6796526
DOPL ACTIVE LICENSE, UTAH
UT
Enumeration date
03/06/2008
Last updated
04/21/2022
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