MEDICARE: DR. MICHAEL WILLIAM WILLETT M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	G56481	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1134182348
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL WILLIAM WILLETT M.D.

Provider Business Mailing Address
First Line	:	155 DIGGLES STREET
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027
Country	:	US
Telephone Number	:	530-467-5393
Fax Number	:

Provider Business Practice Location Address
First Line	:	155 DIGGLES STREET
Second Line	:
City	:	ETNA
State	:	CA
Zip	:	96027
Country	:	US
Telephone Number	:	530-467-5393
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/10/2006
Last Update Date	:	08/17/2010

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