Individual
GREGORY OLSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
W5525 SOUTHDALE DR, LA CROSSE, WI 54601-7147
(773) 671-2628
Mailing address
W5525 SOUTHDALE DR, LA CROSSE, WI 54601-7147
(773) 671-2628
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
036081064
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036081064
—
IL
Enumeration date
02/01/2006
Last updated
03/16/2009
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