Provider Demographics
NPI:1861496366
Name:OLSON, ERIK K (MD)
Entity type:Individual
Prefix:DR
First Name:ERIK
Middle Name:K
Last Name:OLSON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:1 AUDUBON PLAZA DR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1318
Practice Address - Country:US
Practice Address - Phone:502-636-7225
Practice Address - Fax:502-636-8032
Is Sole Proprietor?:No
Enumeration Date:2005-06-13
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY38906207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY50005993OtherPASSPORT GROUP # 1172544
KY500005994OtherPASSPORT GROUP # 50000548
KY000000275811Other12 DIGIT BCBS/KY NUMBER
KY64089808Medicaid
KY000000060164Other12 DIGIT BCBS/KY NUMBER
KY50005993OtherPASSPORT GROUP # 1172544
KY0754611Medicare ID - Type UnspecifiedMEDICARE GROUP # 7546