Provider Demographics
NPI:1629364807
Name:WILLEY, DAVID MATTHEW (MD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:MATTHEW
Last Name:WILLEY
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 1:13351 S ARAPAHO DR
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66062-1520
Mailing Address - Country:US
Mailing Address - Phone:913-353-3000
Mailing Address - Fax:913-353-3001
Practice Address - Street 1:13351 S ARAPAHO DR
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1520
Practice Address - Country:US
Practice Address - Phone:913-353-3000
Practice Address - Fax:913-353-3001
Is Sole Proprietor?:No
Enumeration Date:2011-06-25
Last Update Date:2017-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-377222084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry