Provider Demographics
NPI:1285629923
Name:OLSON, ELIS YNGVE (MD)
Entity type:Individual
Prefix:
First Name:ELIS
Middle Name:YNGVE
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 43
Mailing Address - Street 2:
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55440-0043
Mailing Address - Country:US
Mailing Address - Phone:612-262-1166
Mailing Address - Fax:612-262-4258
Practice Address - Street 1:2925 CHICAGO AVE
Practice Address - Street 2:
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55407-1321
Practice Address - Country:US
Practice Address - Phone:651-241-9700
Practice Address - Fax:651-241-9683
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2025-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL00020602207LP3000X, 207P00000X
NV15576207PP0204X, 208000000X
CAG157727208000000X
VA01012643102080P0204X
NC99003142080P0204X
MN759352080P0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080P0204XAllopathic & Osteopathic PhysiciansPediatricsPediatric Emergency Medicine
No207LP3000XAllopathic & Osteopathic PhysiciansAnesthesiologyPediatric Anesthesiology
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
No207PP0204XAllopathic & Osteopathic PhysiciansEmergency MedicinePediatric Emergency Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL000032416Medicaid
AL2011312OtherUNITED HEALTH CARE
AL200174262OtherTRICARE
AL051518178OtherBCBS OF ALABAMA
AL200174262OtherCHAMPUS
ALN18178OtherMAILHANDLERS
AL009939515Medicaid
AL051032416OtherBCBS
AL4297420OtherAETNA
AL051032416Medicare PIN
AL2011312OtherUNITED HEALTH CARE
AL051518178OtherBCBS OF ALABAMA