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NPI Code Detail

MEDICARE: MR. MICHAEL L WILLIS ADULT NURSE PRACTITI

MEDICARE: MR. MICHAEL L WILLIS ADULT NURSE PRACTITI
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
1363LA2200XAdult Health Nurse Practitioner302775NY

General Provider Information

NPI Number : 1235363847
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL L WILLIS ADULT NURSE PRACTITI
Provider Business Mailing Address
First Line : 3201 KINGS HIGHWAY
Second Line :
City : BROOKLYN
State : NY
Zip : 11234-2625
Country : US
Telephone Number : 718-677-6669
Fax Number :
Provider Business Practice Location Address
First Line : 3201 KINGS HIGHWAY
Second Line : BETH ISRAEL MEDICAL CENTER
City : BROOKLYN
State : NY
Zip : 11234-2625
Country : US
Telephone Number : 718-677-6669
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/11/2009
Last Update Date : 05/11/2009

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