Individual
JON OLSEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1775 DEMPSTER, PARK RIDGE, IL 60068
(847) 723-7624
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
207P00000X
Emergency Medicine Physician
Primary
036075520
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036075520
—
IL
Enumeration date
11/07/2006
Last updated
02/20/2023
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