Individual
LISA OLDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
5250 OLD ORCHARD RD STE 300, SKOKIE, IL 60077-4462
(773) 814-8598
(847) 983-3401
Mailing address
615 GREGORY AVE, WILMETTE, IL 60091-3419
(773) 814-8598
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
036-094872
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036-094872
—
IL
Enumeration date
07/04/2006
Last updated
07/10/2019
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