Organization
KURT F. OLSEN, M.D.,S.C.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. KURT F. OLSEN M.D. (PRESIDENT)
(847) 967-1149
Entity
Organization
Contact information
Practice address
680 N LAKE SHORE DR, CHICAGO, IL 60611-4546
(312) 654-8700
Mailing address
8135 N MILWAUKEE AVE, NILES, IL 60714-2828
(847) 967-1149
(847) 967-8594
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
—
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01636421
BLUE SHIELD OF ILLINOIS
IL
Enumeration date
07/02/2006
Last updated
07/17/2007
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