Provider Demographics
NPI:1043098783
Name:TOM WILLIM, PA-C PLLC
Entity Type:Organization
Organization Name:TOM WILLIM, PA-C PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIM
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:480-999-2559
Mailing Address - Street 1:16122 E GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3111
Mailing Address - Country:US
Mailing Address - Phone:602-717-1954
Mailing Address - Fax:
Practice Address - Street 1:2425 S STEARMAN DR STE 210
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85286-5042
Practice Address - Country:US
Practice Address - Phone:480-999-2559
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207KA0200XAllopathic & Osteopathic PhysiciansAllergy & ImmunologyAllergyGroup - Single Specialty