Provider Demographics
NPI:1174501621
Name:WILLIS, WILLIAM H (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:H
Last Name:WILLIS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:4720 TURNBRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-2743
Mailing Address - Country:US
Mailing Address - Phone:419-882-0455
Mailing Address - Fax:
Practice Address - Street 1:3829 WOODLEY RD
Practice Address - Street 2:BLDG B
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-1171
Practice Address - Country:US
Practice Address - Phone:419-474-9324
Practice Address - Fax:419-474-9345
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-01-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-032467207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0140887OtherBMCH
OHFO1957Medicare UPIN
OH0140887OtherBMCH