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NPI Code Detail

MEDICARE: TIFFANY WILLIS MD

MEDICARE: TIFFANY WILLIS MD
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
1207Q00000XFamily Medicine Physician36129IA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
139640OTHERWELLMARK

General Provider Information

NPI Number : 1750370383
Entity Type Code : Individual
Provider Name (Legal Business Name) : TIFFANY WILLIS MD
Provider Business Mailing Address
First Line : 255 W LUCAS ST
Second Line :
City : MARENGO
State : IA
Zip : 52301-1331
Country : US
Telephone Number : 319-642-5213
Fax Number : 319-642-3636
Provider Business Practice Location Address
First Line : 255 W LUCAS ST
Second Line :
City : MARENGO
State : IA
Zip : 52301-1331
Country : US
Telephone Number : 319-642-5213
Fax Number : 319-642-3636
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/17/2005
Last Update Date : 04/11/2025

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Directions to “ TIFFANY WILLIS MD” Practice Location

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