MICHELLE DIANNE WILLIS (NPI# 1255567574) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255567574 |
| Entity Type | Individual |
| Full Name | MICHELLE DIANNE WILLIS |
| Credential | DO |
| Practice Address |
12151 Regency Pkwy Ste 155 Huntley IL 60142-7644 |
| Practice Telephone | 8475064400 |
| Mailing Telephone | 8475064400 |
| Enumeration Date | 2009-06-01 |
| Last Update Date | 2020-10-16 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 207Q00000X | Family Medicine | 036130518 | IL | Allopathic & Osteopathic Physicians |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| IL | 036130518 | 05 |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 1975 Lin Lor Ln Ste 205, Elgin, IL 601234946 | 8477424111 | 8477424545 |
| 2201 Randall Rd, Carpentersville, IL 601103355 | 8475511859 | 8477830628 |
| 2425 Fargo Blvd, Geneva, IL 601343591 | 6302322200 | 6302321940 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922305051 | Michelle L Willis | Nurse Practitioner | 25 Business Park Dr, Greenbrier, AR 72058-9263 | 2011-02-25 |
| 1790710432 | Michelle Renee Willis | Social Worker | 5570 Sterrett Pl, Suite 101, Columbia, MD 21044-2641 | 2006-07-11 |
| 1386255180 | Michelle Willis | Technician | 281 Maple Ave, Oak Hill, WV 25901-3475 | 2020-08-14 |
| 1285275503 | Michelle J Willis | Technician | 1711 Benning Rd Ne Apt F14, Washington, DC 20002-7250 | 2019-10-08 |
| 1780244582 | Michelle Lynn Willis | Social Worker | 1110 Benfield Blvd Ste B, Millersville, MD 21108-2644 | 2019-06-14 |
| 1770047557 | Michelle Rene Willis | Nurse Practitioner | 3901 E 32nd St, Joplin, MO 64804-3312 | 2019-01-26 |
| 1952762098 | Michelle Willis | Occupational Therapist | 3311 Burnt Mill Dr, Wilmington, NC 28403-2654 | 2016-03-17 |
| 1356747604 | Michelle Willis | Physical Therapist | 507 S Main St, Viroqua, WI 54665-2059 | 2014-11-14 |
| 1548505993 | Michelle Y Willis | Registered Nurse | 3101 Burnet Ave, Cincinnati, OH 45229-3014 | 2012-12-11 |
| 1871737585 | Michelle L Willis | Respiratory Therapist, Certified | 5806 Cooper Chapel Rd, Louisville, KY 40229-1312 | 2009-04-24 |
| Street Address |
12151 REGENCY PKWY STE 155 |
| City | HUNTLEY |
| State | IL |
| Zip Code | 60142-7644 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164022901 | American Drug Stores LLC | Durable Medical Equipment & Medical Supplies | 10090 Route 47, Huntley, IL 60142 | 2020-10-30 |
| 1881201895 | Activefit Physical Therapy and Personal Training | Physical Therapist | 12172 S. Route 47, #125, Huntley, IL 60142 | 2020-09-24 |
| 1710512801 | Shoptikal LLC | Eyewear Supplier (Equipment, not the service) | 9940 Rt 47, Huntley, IL 60142 | 2020-03-09 |
| 1427689744 | Gilberts Evolve LLC | Chiropractor | 9738 Illinois Hwy 47, Huntley, IL 60142 | 2020-01-27 |
| 1790332898 | Mary Casper | Technician | 12829 Mesa St, Huntley, IL 60142 | 2019-08-22 |
| 1437719838 | Faith A Furst | Student in an Organized Health Care Education/Training Program | 12300 Il-47, Huntley, IL 60142 | 2019-06-18 |
| 1578046934 | Shelby Osterberg | Physical Therapist | 12112 S Rt 47, Huntley, IL 60142 | 2018-09-12 |
| 1801378229 | Emilyn Pollack | Nurse Practitioner | 9850 Grimley, Huntley, IL 60142 | 2018-09-01 |
| 1215452537 | Jennifer Amanda Baudin | Occupational Therapy Assistant | 10580 Oakland Ct, Huntley, IL 60142 | 2017-08-08 |
| 1902336555 | Tyler J Wylde | Dentist | 12222 Il-47, Huntley, IL 60142 | 2017-06-15 |
| Find all providers in zip 60142 | ||||
| Taxonomy Code | 207Q00000X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Family Medicine |
| Family Medicine is the medical specialty which is concerned with the total health care of the individual and the family. It is the specialty in breadth which integrates the biological, clinical, and behavioral sciences. The scope of family medicine is not limited by age, sex, organ system, or disease entity. |
| Notes: Source: American Board of Family Medicine [1/1/2007: changed title; 7/1/2007: added definition, added source; 7/1/2017: modified definition] - Note: The American Osteopathic Board of Family Physicians certification includes extensive use of Osteopathic Manipulative Treatment (OMT), which integrates the biological, clinical, and behavioral sciences. - Additional Resources: American Board of Family Medicine, www.theabfm.org. American Osteopathic Board of Family Physicians, www.osteopathic.org/certification - Board certification for Medical Doctors (MDs) is provided by the American Board of Family Medicine. Board certification for Doctors of Osteopathy (DOs) is provided by the American Osteopathic Board of Family Physicians or the American Board of Family Medicine. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1568904597 | Centegra Primary Care LLC | Family Medicine | 10370 Haligus Rd, Suite 201, Huntley, IL 60142 | 2016-11-08 |
| 1689093544 | Alicia Marie Waite | Family Medicine | 13900 Quality Drive, Huntley, IL 60142 | 2014-04-08 |
| 1417122813 | Jerome Robert Walker | Family Medicine | 12432 Pheasant Ridge Dr, Huntley, IL 60142-7465 | 2008-04-25 |
| 1497816268 | Amrit R Singh | Family Medicine | 12179 Regency Pkwy, Vitas Healthcare and Hospice, Huntley, IL 60142-7644 | 2006-12-13 |
| 1568579571 | Ramon A Gonzalez | Family Medicine | 12525 Regency Pkwy, Suite F, Huntley, IL 60142-6500 | 2006-08-24 |
| 1194006742 | Pooja Srinivas Dewilde | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2011-09-08 |
| 1073620175 | Anita N Szeto | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2006-08-24 |
| 1255350666 | Rodrigo Bastidas | Family Medicine | 10350 Haligus Rd Ste 200, Huntley, IL 60142 | 2006-07-18 |
| 1376583658 | Marietta P Abraham | Family Medicine | 10350 Haligus Rd, Huntley, IL 60142-9545 | 2006-06-07 |
| 1669430567 | Fazal Khan | Family Medicine | 10350 Haligus Rd, Huntley, IL 60142-9558 | 2006-05-02 |
| Find all providers in HUNTLEY | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.