Individual
DAVID C. WILLYARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
D.O.
Contact information
Practice address
512 PROFESSIONAL WAY, KENDALLVILLE, IN 46755-2927
(260) 347-8556
(260) 347-8557
Mailing address
11109 PARKVIEW PLAZA DR # 117, FORT WAYNE, IN 46845-1701
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
02000891A
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000111943
ANTHEM
IN
01
—
000000570546
ANTHEM
IN
01
—
00001004235 01
UNITED HEALTHCARE
—
01
—
080130360
RAILROAD MEDICARE
IN
05
—
100263140
—
IN
01
—
2022
PHYSICIANS HEALTH PLAN
IN
01
—
3937240016
MEDICARE DMEPOS
IN
01
—
4205599
AETNA
—
Enumeration date
12/29/2005
Last updated
10/20/2022
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