Provider Demographics
NPI:1043207681
Name:WILLEY, DAVID ALLEN (MD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:ALLEN
Last Name:WILLEY
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1200 CHASKA CREEK WAY
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318
Mailing Address - Country:US
Mailing Address - Phone:952-856-1046
Mailing Address - Fax:952-856-1049
Practice Address - Street 1:1200 CHASKA CREEK WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-2152
Practice Address - Country:US
Practice Address - Phone:952-448-3303
Practice Address - Fax:952-448-4409
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2019-01-03
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Provider Licenses
StateLicense IDTaxonomies
MN23682207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN174568900Medicaid
MN174568900Medicaid
089001513Medicare ID - Type Unspecified