# MR. JOEL S WILLIS

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- **Entity:** Individual
- **Status:** Active
- **Sole proprietor:** No

## Provider details

- **NPI number:** 1205169760
- **Gender:** Man
- **Credential:** DO

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | 35-050910 | OH | Yes |
| 207Q00000X | Family Medicine Physician | DO034845 | DC | — |

## Other

- **Enumeration date:** 09/15/2009
- **Last updated:** 02/24/2021

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 05 | — | 370966854002 | — | IL |
| 05 | — | 370966854005 | — | IL |
| 01 | — | CF3444 | MEDICARE RR | IL |