Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | 10122 | MT |
NPI | 1023197464 |
---|---|
Provider Name | Michael C. Willis |
First Address | Billings, MT 59107-5100 |
Second Address | Billings, MT 59101-1107 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/11/2006 |
Last Update Date | 27/02/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0046546 | MDCD PIN (01) | MT |
H25032 | (02) | MT |