MEDICARE: WILLOW MEDICAL GROUP

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	111N00000X	Chiropractor	FNP32191	CA

General Provider Information

NPI Number	:	1205050119
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLOW MEDICAL GROUP

Provider Business Mailing Address
First Line	:	3311 E WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2310
Country	:	US
Telephone Number	:	562-424-4976
Fax Number	:	562-424-5960

Provider Business Practice Location Address
First Line	:	3311 E WILLOW ST
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90806-2310
Country	:	US
Telephone Number	:	562-424-4976
Fax Number	:	562-424-5960

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	LAWRENCE MILLER
Credential	:	M.D.
Telephone Number	:	562-424-4976

Provider Enumeration Date	:	04/12/2007
Last Update Date	:	08/22/2020

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Directions to “WILLOW MEDICAL GROUP ” Practice Location

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