Provider Demographics
NPI:1992123012
Name:OLSON, LUKE CURRAN
Entity type:Individual
Prefix:
First Name:LUKE
Middle Name:CURRAN
Last Name:OLSON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:611 E HILLCREST DR
Mailing Address - Street 2:
Mailing Address - City:VERONA
Mailing Address - State:WI
Mailing Address - Zip Code:53593-1517
Mailing Address - Country:US
Mailing Address - Phone:608-469-3983
Mailing Address - Fax:
Practice Address - Street 1:71 HAYNES STREET
Practice Address - Street 2:PATHOLOGY DEPT.
Practice Address - City:MANCHESTER
Practice Address - State:CT
Practice Address - Zip Code:06040
Practice Address - Country:US
Practice Address - Phone:860-647-6487
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-04
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA285793207ZP0102X
CT66540207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology