Individual
DR. SAM ALLEN DETWILER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD, ATC
Contact information
Practice address
3901 RAINBOW BLVD # MS 2027, KANSAS CITY, KS 66160-0006
(913) 588-3974
Mailing address
3901 RAINBOW BLVD # MS 1046, KANSAS CITY, KS 66160-8500
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
Primary
94-11926
KS
2255A2300X
Athletic Trainer
AT8023
TX
Other
Enumeration date
03/30/2017
Last updated
06/13/2024
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