Thomas Rice Willett, D.O.
Individual provider Active NPI Family Medicine Physician · Green Lake, WI
NPI 1902806243 · NPPES record last updated Dec 31, 2009
Key facts
- NPI
- 1902806243
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Medicine Physician 207Q00000X
- License
- 17659 (WI)
- Practice address
- N6205 Busse Rd
Green Lake, WI 54941-8500 - Phone
- (920) 294-3444
- Fax
- (920) 294-6660
- NPI assigned
- Jul 28, 2005
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Doctor of Osteopathy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 17659 | WI | MD | Family Medicine Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Green Lake Medical Clinic | Past | Accepting new patients | |
| Jeffrey G. Bentson, M.D., PLLC | Past | Accepting new patients | |
| Community Medical Center of Green Lake, LLC | Family Medicine | Past | Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Medicine Physician | 207Q00000X | 17659 | WI | Yes |
Addresses
Primary practice location
N6205 Busse Rd
Green Lake, WI 54941-8500
Mailing address
PO Box 429
N6250 Busse Drive
Green Lake, WI 54941-0429
Phone (920) 294-3444
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 391253020 | Other | WI | TAX IDENTIFICATION NUMBER |
| 30020000 | Medicaid | WI | |
| 391253020013 | Other | WI | BLUE CROSS/BLUE SHIELD |
Other providers in Green Lake, WI
- Lisa Ann Rollin
- Sandra Schwoerer
- Wesley A Shemanski
- Abby Noel Vogt
- Nichol Wienkes
- Xtreme Care LLC
- York Behavioral Health LLC
- Brooke D Zank
All providers in Green Lake, WI · Family Medicine Physician in Wisconsin
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 31, 2009. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.