MEDICARE: WILLARD PETER DEBRABER D.O.

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	174400000X	Specialist	5101006662	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	101551	OTHER	MI	PREFERRED CHOICES
2	3456139255	OTHER	MI	COMM
3	1429	OTHER	MI	PH
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
5	1910582	OTHER	MI	UNITED HEALTHCARE
6	3456110440	OTHER	MI	BCR
7	P54169	OTHER	MI	BCN
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	4098761	OTHER	MI	AETNA
10	382273611	OTHER	MI	COMM

General Provider Information

NPI Number	:	1255334397
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WILLARD PETER DEBRABER D.O.

Provider Business Mailing Address
First Line	:	1761 WELLS AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-2459
Country	:	US
Telephone Number	:	231-773-3228
Fax Number	:	231-773-3482

Provider Business Practice Location Address
First Line	:	1761 WELLS AVE
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49442-2459
Country	:	US
Telephone Number	:	231-773-3228
Fax Number	:	231-773-3482

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	04/07/2015

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