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LAWRENCE A DETWILER

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
M.D.

Contact information

Practice address
7575 NORTHCLIFF AVE, SUITE 102, BROOKLYN, OH 44144-3267
(216) 398-8196
(216) 398-8192
Mailing address
7575 NORTHCLIFF AVE, SUITE 102, BROOKLYN, OH 44144-3267
(216) 398-8196
(216) 398-8192

Taxonomy

Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
35-04-2991
OH

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
000000030812
ANTHEM BCBS
OH
05
0517088
OH
01
105347
KAISER
OH
01
110146704
RAILROAD MEDICARE
OH
01
341847368031
CARESOURCE
OH
01
393375
WELLCARE OF OH
OH
01
4009105
AETNA
OH
01
57106
TRICARE
OH
01
P42991
SUMMACARE HEALTH PLAN
OH
Enumeration date
08/17/2005
Last updated
05/30/2008
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