MEDICARE: ALLIE KATHARINE OLMSTEAD DO

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	2086S0129X	Vascular Surgery Physician	W3852	TX

General Provider Information

NPI Number	:	1619438835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ALLIE KATHARINE OLMSTEAD DO

Provider Business Mailing Address
First Line	:	2525 TURTLE CREEK BLVD APT 609
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75219-6113
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	621 N HALL ST
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75226-1339
Country	:	US
Telephone Number	:	214-821-9600
Fax Number	:

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

Provider Enumeration Date	:	03/29/2019
Last Update Date	:	05/26/2026

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