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General NPI Number Information
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NPI Number | 1043207681
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Entity Type | Individual
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Provider Name | DAVID ALLEN WILLEY MD
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Gender | Male
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Dates
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Enumeration Date | 09/29/2005
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Last Update Date | 01/03/2019
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Provider Practice Location Address
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Address Line | 1200 CHASKA CREEK WAY SUITE 200
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City | CHASKA
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State | MN
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Zip | 55318-2152
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Country | US
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Telephone | 952-448-3303
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Fax | 952-448-4409
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Provider Business Mailing Address
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Address Line | 1200 CHASKA CREEK WAY SUITE 200
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City | CHASKA
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State | MN
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Zip | 55318
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Country | US
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Telephone | 952-856-1046
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Fax | 952-856-1049
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 23682
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License Number State | MN
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