Healthcare Provider Details

I. General information

NPI: 1962471730
Provider Name (Legal Business Name): THOMAS G WILLMENG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2006
Last Update Date: 04/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

315 TURWILL LN
KALAMAZOO MI
49006-4231
US

IV. Provider business mailing address

601 JOHN ST BOX 42
KALAMAZOO MI
49007-5341
US

V. Phone/Fax

Practice location:
  • Phone: 269-343-8170
  • Fax: 269-382-2388
Mailing address:
  • Phone: 269-341-8419
  • Fax: 269-341-8743

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number4301028285
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: