Individual ProviderMary OlsonRadiologyAllopathic & Osteopathic PhysiciansPractice Address2160 S First Ave, (Mcgaw Ent., Rm. 47), Maywood, IL 60153(708) 216-5221PECOS EnrollmentBased on the most recent information from CMS, provider Mary Olson does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 7 days ago.Profile DetailsProvider ID1942287818Provider TypeIndividualFull NameOlson, MaryCredentialMDGenderFemaleSole ProprietorNoEnumeration Date12/30/2005Last Updated3/4/2010Contact InformationPractice LocationPractice Address2160 S First Ave, (Mcgaw Ent., Rm. 47), Maywood, IL 60153Phone(708) 216-5221Fax(708) 216-0899Mailing LocationMailing Address2160 S First Ave, (Mcgaw Ent., Rm. 47), Maywood, IL 60153Phone(708) 216-5221Fax(708) 216-0899Provider TaxonomiesCodeDescriptionLicenseCode2085R0202XPrimaryDescriptionRadiologyAllopathic & Osteopathic PhysiciansLicense36067222IllinoisProvider IdentifiersIDDescriptionIssuerID36067222DescriptionMedicaidIssuerUnlistedIllinois