Healthcare Provider Details

I. General information

NPI: 1174501621
Provider Name (Legal Business Name): WILLIAM H. WILLIS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3829 WOODLEY RD BLDG B
TOLEDO OH
43606-1171
US

IV. Provider business mailing address

4720 TURNBRIDGE RD
TOLEDO OH
43623-2743
US

V. Phone/Fax

Practice location:
  • Phone: 419-474-9324
  • Fax: 419-474-9345
Mailing address:
  • Phone: 419-882-0455
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number35-032467
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: