Provider Demographics
NPI:1184641771
Name:WILLMAN, DONALD E (DO)
Entity Type:Individual
Prefix:
First Name:DONALD
Middle Name:E
Last Name:WILLMAN
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:751 KENMOOR AVENUE SE BRIGHTWAVE PAIN THERAPY
Mailing Address - Street 2:
Mailing Address - City:GRAND RAPIDS
Mailing Address - State:MI
Mailing Address - Zip Code:49546
Mailing Address - Country:US
Mailing Address - Phone:616-608-5551
Mailing Address - Fax:616-608-5551
Practice Address - Street 1:751 KENMOOR AVENUE SE BRIGHTWAVE PAIN THERAPY
Practice Address - Street 2:
Practice Address - City:GRAND RAPIDS
Practice Address - State:MI
Practice Address - Zip Code:49546
Practice Address - Country:US
Practice Address - Phone:616-608-5551
Practice Address - Fax:616-608-5551
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-17
Last Update Date:2019-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS-3647207P00000X
WI25116-021207P00000X
OH34 002975207P00000X
MI5101006554207P00000X
KY01995207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI3469627Medicaid
MI3469645Medicaid
MI1184641771Medicaid
MI5651018OtherBCBS
MIDW006554OtherBLUESHIELD
MI3469627Medicaid
MI0M57650001Medicare PIN
MIP29950009Medicare PIN
MI0M57720009Medicare PIN
MIDW006554OtherBLUE SHIELD
MI1184641771Medicaid