Provider Demographics
NPI:1073876090
Name:WILL, MICHAEL LAWRENCE (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:LAWRENCE
Last Name:WILL
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4009 ORCHARD DR
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:MI
Mailing Address - Zip Code:48640-6122
Mailing Address - Country:US
Mailing Address - Phone:989-389-3515
Mailing Address - Fax:
Practice Address - Street 1:42575 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:PALM DESERT
Practice Address - State:CA
Practice Address - Zip Code:92211-8850
Practice Address - Country:US
Practice Address - Phone:760-360-0333
Practice Address - Fax:760-360-1053
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-25
Last Update Date:2024-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301101299207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine