Healthcare Provider Details

I. General information

NPI: 1134433204
Provider Name (Legal Business Name): CHRISTOPHER MICHAEL WILLKOMM M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2010
Last Update Date: 05/26/2022
Certification Date: 05/26/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 HEALTHCARE WAY
NORTH VENICE FL
34275-3669
US

IV. Provider business mailing address

PO BOX 947407
ATLANTA GA
30394-7407
US

V. Phone/Fax

Practice location:
  • Phone: 941-261-2000
  • Fax: 941-261-0880
Mailing address:
  • Phone: 941-917-2600
  • Fax: 941-917-7884

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License NumberME107405
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: