Individual
MR. KENNETH MICHAEL OLSON
Active
Sole proprietor
Provider details
NPI number
Gender
Man
Credential
P.A. - C
Contact information
Practice address
915 N GRAND BLVD, 11F/JC ST. LOUIS VA, SAINT LOUIS, MO 63106-1621
(314) 652-4100
Mailing address
840 CASTLEAIRE PKWY, SAINT LOUIS, MO 63129-2049
(314) 892-6195
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
—
—
Other
Enumeration date
04/04/2006
Last updated
07/08/2007
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