Organization
BRIAN OLOFSSON MD, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRIAN OLOFSSON MD (PHYSICIAN/OWNER)
(815) 932-5725
Entity
Organization
Contact information
Practice address
400 N WALL ST STE 510, KANKAKEE, IL 60901-2965
(815) 932-5725
(815) 932-5872
Mailing address
400 N WALL ST STE 510, KANKAKEE, IL 60901-2965
(815) 932-5725
(815) 932-5872
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
036067325
—
IL
Enumeration date
01/16/2019
Last updated
01/16/2019
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