Provider Demographics
NPI:1558622506
Name:WILLS, CHRISTOPHER BRADLEY (DO)
Entity Type:Individual
Prefix:DR
First Name:CHRISTOPHER
Middle Name:BRADLEY
Last Name:WILLS
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 1:7322 236TH AVE
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:WI
Mailing Address - Zip Code:53168-9664
Mailing Address - Country:US
Mailing Address - Phone:262-671-7550
Mailing Address - Fax:262-671-7555
Practice Address - Street 1:7322 236TH AVE
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:WI
Practice Address - Zip Code:53168-9664
Practice Address - Country:US
Practice Address - Phone:262-671-7550
Practice Address - Fax:262-671-7555
Is Sole Proprietor?:No
Enumeration Date:2012-06-06
Last Update Date:2020-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI64174207R00000X
MI5101019951207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WIK400616957OtherMEDICARE