Healthcare Provider Details

I. General information

NPI: 1285541276
Provider Name (Legal Business Name): NORMAN D WILLS
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 08/25/2026
Certification Date: 08/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9747 HARBOR CT APT D
INDIANAPOLIS IN
46229-1776
US

IV. Provider business mailing address

9747 HARBOR CT APT D
INDIANAPOLIS IN
46229-1776
US

V. Phone/Fax

Practice location:
  • Phone: 385-210-4550
  • Fax:
Mailing address:
  • Phone: 385-210-4550
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172A00000X
TaxonomyDriver
License Number8960518220
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: