Healthcare Provider Details

I. General information

NPI: 1972655363
Provider Name (Legal Business Name): MICHAEL J WILLENBORG MD PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 LONG PRAIRIE RD
FLOWER MOUND TX
75022-4845
US

IV. Provider business mailing address

2960 LONG PRAIRIE RD
FLOWER MOUND TX
75022-4845
US

V. Phone/Fax

Practice location:
  • Phone: 972-420-1776
  • Fax: 972-436-6996
Mailing address:
  • Phone: 972-420-1776
  • Fax: 972-436-6996

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberL3525
License Number StateTX

VIII. Authorized Official

Name: MICHAEL JOSEPH WILLENBORG
Title or Position: M.D.
Credential: M.D.
Phone: 972-420-1776