Healthcare Provider Details

I. General information

NPI: 1275021883
Provider Name (Legal Business Name): REBECCA NEKOLAICHUK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2018
Last Update Date: 08/26/2022
Certification Date: 08/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 RED RIVER ST
AUSTIN TX
78701-1918
US

IV. Provider business mailing address

UT AUSTIN DELL MEDICAL SCHOOL INTERNAL MEDICINE 1500 RED RIVER
AUSTIN TX
78701
US

V. Phone/Fax

Practice location:
  • Phone: 512-324-8355
  • Fax:
Mailing address:
  • Phone: 512-324-8355
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberBP10063753
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberT1864
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: