Provider Demographics
NPI:1922175249
Name:MICHELE E. WILLEY D.O. P.A.
Entity Type:Organization
Organization Name:MICHELE E. WILLEY D.O. P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELE
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:WILLEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-372-0999
Mailing Address - Street 1:22065 STATE ROAD 7
Mailing Address - Street 2:
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33428-4219
Mailing Address - Country:US
Mailing Address - Phone:561-372-0999
Mailing Address - Fax:
Practice Address - Street 1:22065 STATE ROAD 7
Practice Address - Street 2:
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33428-4219
Practice Address - Country:US
Practice Address - Phone:561-372-0999
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7138207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLG55413Medicare UPIN
FLK9775Medicare ID - Type UnspecifiedGROUP #