Provider Demographics
NPI:1205805595
Name:OLSEN, GARRICK B (MD)
Entity type:Individual
Prefix:DR
First Name:GARRICK
Middle Name:B
Last Name:OLSEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:8675 VALLEY CREEK RD
Mailing Address - Street 2:
Mailing Address - City:WOODBURY
Mailing Address - State:MN
Mailing Address - Zip Code:55125-2337
Mailing Address - Country:US
Mailing Address - Phone:651-241-3000
Mailing Address - Fax:
Practice Address - Street 1:8675 VALLEY CREEK RD
Practice Address - Street 2:
Practice Address - City:WOODBURY
Practice Address - State:MN
Practice Address - Zip Code:55125-2337
Practice Address - Country:US
Practice Address - Phone:651-241-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-17
Last Update Date:2021-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN40779207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN122598OtherUCARE MINNESOTA
MNNA9141017254OtherPREFERRED ONE
MN01-04637OtherMEDICA
MN080163031OtherRAILROAD MEDICARE
MNHP29224OtherHEALTH PARTNERS
MN34010700OtherGROUP HEALTH EAU CLAIRE
MN947813OtherAMERICAS PPO
MN66-02413OtherMEDICA URGENT CARE
MN771514500Medicaid
MN26F630LOtherBLUE CROSS
MN34010700OtherMEDICAID WI
MN34010700OtherGROUP HEALTH EAU CLAIRE
MN66-02413OtherMEDICA URGENT CARE