NPIMap

Individual provider Active NPI

Brendan Charles-Mulligan Wille, PA-C

  • Physician Assistant
  • Lake Orion, MI
National Provider Identifier
1063233963
Registry record updated Mar 9, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
5601012822 Issued in MI
Practice address
1455 S Lapeer Rd Ste 100
Lake Orion, MI 48360-1468
Phone
(248) 693-3551
Fax
(248) 693-4643
NPI assigned
Oct 23, 2024
Last updated
Mar 9, 2026By the provider in NPPES
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 9, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 5601012822 MI Primary

Addresses

Primary practice location

1455 S Lapeer Rd Ste 100
Lake Orion, MI 48360-1468

Mailing address

25010 30 Mile Rd
Lenox, MI 48050-1501
Phone (248) 770-6356

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MI
Eligible to order & refer
  • Part B services
  • Medical equipment
  • Home health
  • Power mobility devices
  • Hospice
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20250114002098 MI Practitioner - Physician Assistant 3375071624 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2024
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Orion Family Physicians PCGroup PAC ID 0143212712, 11 clinicians

Practice addresses (Care Compare)

1455 S Lapeer Rd
Lake Orion, MI 48360-1468
Phone (248) 693-3551

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

Interoperability endpoints

  • Direct secure messaging: brendanwille@ofp.allscriptsdirect.net

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 11

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1729641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773014400000",
    "number": "1063233963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "25010 30 MILE RD",
            "city": "LENOX",
            "state": "MI",
            "postal_code": "480501501",
            "telephone_number": "248-770-6356"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1455 S LAPEER RD STE 100",
            "city": "LAKE ORION",
            "state": "MI",
            "postal_code": "483601468",
            "telephone_number": "248-693-3551",
            "fax_number": "248-693-4643"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILLE",
        "first_name": "BRENDAN",
        "middle_name": "CHARLES-MULLIGAN",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2024-10-23",
        "last_updated": "2026-03-09",
        "certification_date": "2026-03-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MI",
            "license": "5601012822",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lake Orion, MI

Sources for this page

Verify at the official NPI Registry.