# WILLARD P DEBRABER DO PC

> Is this information incorrect? This page shows public data from NPPES. Update your record in NPPES and this page will update automatically within 7 days. [Update your NPPES record](https://nppes.cms.hhs.gov)

- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1356663413
- **Authorized official:** DR. WILLARD PETER DEBRABER D.O. (PRESIDENT)
- **Authorized official phone:** (231) 773-3228

## Contact information

- **Practice address:** 1761 WELLS AVE, MUSKEGON, MI 49442-2459
- **Practice address phone:** (231) 773-3228
- **Practice address fax:** (231) 773-3482
- **Mailing address:** 1761 WELLS AVE, MUSKEGON, MI 49442-2459
- **Mailing address phone:** (231) 773-3228
- **Mailing address fax:** (231) 773-3482

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208800000X | Urology Physician | 5101006662 | MI | Yes |

## Other

- **Enumeration date:** 02/17/2010
- **Last updated:** 05/18/2015

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 1255334397 | TYPE I NPI | MI |
| 05 | — | 2101067 | — | MI |
| 01 | — | 5611044 | BLUE CROSS BLUE SHIELD | MI |