MEDICARE: MICHAEL J WILLENBORG MD PA

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	332B00000X	Durable Medical Equipment & Medical Supplies	L3525	TX

General Provider Information

NPI Number	:	1972655363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MICHAEL J WILLENBORG MD PA

Provider Business Mailing Address
First Line	:	2960 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4845
Country	:	US
Telephone Number	:	972-420-1776
Fax Number	:	972-436-6996

Provider Business Practice Location Address
First Line	:	2960 LONG PRAIRIE RD
Second Line	:
City	:	FLOWER MOUND
State	:	TX
Zip	:	75022-4845
Country	:	US
Telephone Number	:	972-420-1776
Fax Number	:	972-436-6996

Authorized Official
Title or Position	:	M.D.
Name	:	MICHAEL JOSEPH WILLENBORG
Credential	:	M.D.
Telephone Number	:	972-420-1776

Provider Enumeration Date	:	01/17/2007
Last Update Date	:	08/22/2020

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