MEDICARE: ADISA JOANNA WILLMER 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
1	207R00000X	Internal Medicine Physician	A067105	CA
2	207Q00000X	Family Medicine Physician	A067105	CA

General Provider Information

NPI Number	:	1134148562
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ADISA JOANNA WILLMER M.D.

Provider Business Mailing Address
First Line	:	3124 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-2902
Country	:	US
Telephone Number	:	510-535-4400
Fax Number	:	510-261-6438

Provider Business Practice Location Address
First Line	:	3124 INTERNATIONAL BLVD
Second Line	:
City	:	OAKLAND
State	:	CA
Zip	:	94601-2902
Country	:	US
Telephone Number	:	510-535-4400
Fax Number	:	510-261-6438

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/18/2006
Last Update Date	:	01/12/2012

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