MEDICARE: DR. TODD M DETWILER MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	04-26374	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396796181
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TODD M DETWILER MD

Provider Business Mailing Address
First Line	:	1301 W 12TH AVE
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2587
Country	:	US
Telephone Number	:	620-343-2900
Fax Number	:	620-343-9484

Provider Business Practice Location Address
First Line	:	1301 W 12TH AVE
Second Line	:
City	:	EMPORIA
State	:	KS
Zip	:	66801-2587
Country	:	US
Telephone Number	:	620-343-2900
Fax Number	:	620-343-9484

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/15/2006
Last Update Date	:	03/03/2026

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Directions to “ DR. TODD M DETWILER MD” Practice Location

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