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General NPI Number Information
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NPI Number | 1730601162
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Entity Type | Individual
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Provider Name | MICHAEL WILLIAM-MULLIGAN WILLE PA-C
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Gender | Male
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Dates
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Enumeration Date | 07/07/2017
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Last Update Date | 07/05/2018
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Provider Practice Location Address
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Address Line | 17877 W 14 MILE RD
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City | BEVERLY HILLS
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State | MI
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Zip | 48025
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Country | US
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Telephone | 248-644-3920
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Fax | 248-644-2569
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Provider Business Mailing Address
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Address Line | 139 NORTHWOOD AVE
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City | ROCHESTER
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State | MI
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Zip | 48307-1543
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Country | US
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Telephone | 248-930-9547
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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 | 5601008296
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License Number State | MI
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