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NPI Code Detail

MEDICARE: ALEKSANDRA OLSSON-DETWILER M.D.

MEDICARE: ALEKSANDRA OLSSON-DETWILER M.D.
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
1207R00000XInternal Medicine PhysicianL1685TX

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
3P00151113OTHERTXRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
18P9640OTHERTXBCBS
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1740280510
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALEKSANDRA OLSSON-DETWILER M.D.
Provider Business Mailing Address
First Line : PO BOX 132601
Second Line :
City : TYLER
State : TX
Zip : 75713-2601
Country : US
Telephone Number : 903-521-7838
Fax Number : 903-566-3297
Provider Business Practice Location Address
First Line : 1000 S BECKHAM AVE
Second Line :
City : TYLER
State : TX
Zip : 75701-1908
Country : US
Telephone Number : 903-521-7838
Fax Number : 903-566-3297
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2005
Last Update Date : 06/23/2008

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Directions to “ ALEKSANDRA OLSSON-DETWILER M.D.” Practice Location

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