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General NPI Number Information
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NPI Number | 1295987923
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Entity Type | Individual
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Provider Name | THOMAS WILLIM PA
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Gender | Male
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Dates
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Enumeration Date | 10/13/2008
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Last Update Date | 01/27/2024
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Provider Practice Location Address
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Address Line | 16733 E PALISADES BLVD STE 106
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-8322
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Country | US
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Telephone | 809-992-5594
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Fax |
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Provider Business Mailing Address
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Address Line | 16122 E GLENEAGLE DR
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City | FOUNTAIN HILLS
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State | AZ
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Zip | 85268-3111
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Country | US
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Telephone | 602-717-1954
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Fax |
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1559
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License Number State | AZ
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