MEDICARE: JULIO OLIVIERI

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	207R00000X	Internal Medicine Physician	K2549	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	10028091	OTHER		AMERIGROUP IDENTIFICATION
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	4785	OTHER	TX	PARKLAND IDENTIFICATION
4	0057BL	OTHER	TX	BLUECROSS BLUE SHIELD
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1447562541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JULIO OLIVIERI

Provider Business Mailing Address
First Line	:	6300 SAMUELL BLVD
Second Line	:	STE 120
City	:	DALLAS
State	:	TX
Zip	:	75228-7137
Country	:	US
Telephone Number	:	214-381-1910
Fax Number	:	214-381-2868

Provider Business Practice Location Address
First Line	:	6300 SAMUELL BLVD
Second Line	:	STE 120
City	:	DALLAS
State	:	TX
Zip	:	75228-7137
Country	:	US
Telephone Number	:	214-381-1910
Fax Number	:	214-381-2868

Authorized Official
Title or Position	:	PRESIDENT/OWNER
Name	:	JULIO OLIVIERI
Credential	:	M.D.
Telephone Number	:	214-381-1910

Provider Enumeration Date	:	07/06/2010
Last Update Date	:	07/06/2010

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Directions to “JULIO OLIVIERI ” Practice Location

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