Provider Demographics
NPI:1841219201
Name:HILLER, MICHAEL WILSON (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WILSON
Last Name:HILLER
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 1:997 BEAVER CREEK RD
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-9570
Mailing Address - Country:US
Mailing Address - Phone:307-672-3473
Mailing Address - Fax:
Practice Address - Street 1:1898 FORT RD
Practice Address - Street 2:VA MEDICAL CENTER (111)
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-8320
Practice Address - Country:US
Practice Address - Phone:307-672-3473
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2618A207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
WYH27624Medicare UPIN
WY308609Medicare ID - Type Unspecified