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Organization
SAMUEL T. DETWILER, D.O. LLC
Active
Organization
SAMUEL T. DETWILER, D.O. LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SAMUEL T DETWILER D.O. LLC (PRESIDENT)
(330) 876-1111
Entity
Organization
Contact information
Practice address
8231 MAIN ST, KINSMAN, OH 44428-9514
(330) 876-1111
(330) 876-1005
Mailing address
8231 MAIN ST, PO BOX 99, KINSMAN, OH 44428-9514
(330) 876-1111
(330) 876-1005
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34-007985
OH
363LF0000X
Family Nurse Practitioner
NP-04053
OH
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2760016
—
OH
Enumeration date
10/26/2006
Last updated
09/09/2007
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