Provider Demographics
NPI:1295987923
Name:WILLIM, THOMAS (PA)
Entity type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:WILLIM
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16122 E GLENEAGLE DR
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-3111
Mailing Address - Country:US
Mailing Address - Phone:602-717-1954
Mailing Address - Fax:
Practice Address - Street 1:16733 E PALISADES BLVD STE 106
Practice Address - Street 2:
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-8322
Practice Address - Country:US
Practice Address - Phone:809-992-5594
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-13
Last Update Date:2024-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ1559363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical