MEDICARE: DR. MICHAEL SCOTT WILLENS 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	207L00000X	Anesthesiology Physician	OS8432	FL
2	207LP2900X	Pain Medicine (Anesthesiology) Physician	OS8432	FL
3	208VP0014X	Interventional Pain Medicine Physician	OS8432	FL
4	208VP0000X	Pain Medicine Physician	OS8432	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	03193A	OTHER	FL	MEDICARE ID

General Provider Information

NPI Number	:	1932159381
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MICHAEL SCOTT WILLENS D.O.

Provider Business Mailing Address
First Line	:	3003 CLAIRE LN 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-6645
Country	:	US
Telephone Number	:	904-683-2596
Fax Number	:	904-683-2597

Provider Business Practice Location Address
First Line	:	3003 CLAIRE LN 100
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32223-6645
Country	:	US
Telephone Number	:	904-683-2596
Fax Number	:	904-683-2597

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	04/17/2024

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Directions to “ DR. MICHAEL SCOTT WILLENS D.O.” Practice Location

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