Healthcare Provider Details

I. General information

NPI: 1376939728
Provider Name (Legal Business Name): MICHAEL LOUIS BILLET M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 12/22/2023
Certification Date: 12/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 E MARSHALL ST BOX 980401
RICHMOND VA
23298-5051
US

IV. Provider business mailing address

4300 MARKET PTE DR STE 100
BLOOMINGTON MN
55435-5435
US

V. Phone/Fax

Practice location:
  • Phone: 804-828-4860
  • Fax: 804-828-4603
Mailing address:
  • Phone: 952-767-4574
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0101263732
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: