Provider Demographics
NPI:1144242710
Name:ACHLEITNER, OLIVER (MD)
Entity Type:Individual
Prefix:
First Name:OLIVER
Middle Name:
Last Name:ACHLEITNER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5139
Mailing Address - Street 2:
Mailing Address - City:BROWNSVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78523-5139
Mailing Address - Country:US
Mailing Address - Phone:956-982-6982
Mailing Address - Fax:956-982-0436
Practice Address - Street 1:535 PAREDES LINE RD
Practice Address - Street 2:
Practice Address - City:BROWNSVILLE
Practice Address - State:TX
Practice Address - Zip Code:78521-2483
Practice Address - Country:US
Practice Address - Phone:956-982-6982
Practice Address - Fax:956-982-0436
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-24
Last Update Date:2013-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK0586174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP000909G1Medicaid
G37875Medicare UPIN
TXP000909G1Medicaid