Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207X00000X | Orthopaedic Surgeon | L3525 | TX |
N | 207XX0004X | Foot and Ankle Orthopaedic Surgeon | L3525 | TX |
NPI | 1447364658 |
---|---|
Provider Name | Michael Joseph Willenborg |
First Address | Flower Mound, TX 75028-2783 |
Second Address | Flower Mound, TX 75028 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/08/2006 |
Last Update Date | 26/07/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
194933101 | (05) | TX |
8W8230 | BLUECROSS (01) | TX |
H83994 | (02) | TX |
P00602966 | RAILROAD MEDICARE (01) | TX |