MEDICARE: DR. CHRISTOPHER BRADLEY WILLS D.O

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	207R00000X	Internal Medicine Physician	64174	WI
2	207R00000X	Internal Medicine Physician	5101019951	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	K400616957	OTHER	WI	MEDICARE

General Provider Information

NPI Number	:	1558622506
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHRISTOPHER BRADLEY WILLS D.O

Provider Business Mailing Address
First Line	:	7322 236TH AVE
Second Line	:
City	:	SALEM
State	:	WI
Zip	:	53168-9664
Country	:	US
Telephone Number	:	262-671-7550
Fax Number	:	262-671-7555

Provider Business Practice Location Address
First Line	:	7322 236TH AVE
Second Line	:
City	:	SALEM
State	:	WI
Zip	:	53168-9664
Country	:	US
Telephone Number	:	262-671-7550
Fax Number	:	262-671-7555

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

Provider Enumeration Date	:	06/06/2012
Last Update Date	:	01/06/2020

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