Individual
TED S WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(952) 595-1301
(612) 294-4903
Mailing address
3600 MINNESOTA DR STE 800, EDINA, MN 55435-7915
(952) 595-1301
(612) 294-4903
Taxonomy
Speciality
Code
Description
License number
State
2085R0202X
Diagnostic Radiology Physician
Primary
H2908
TX
2085R0202X
Diagnostic Radiology Physician
MD25843
ME
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
134481406
—
TX
01
—
TIN PLUS113
TRICARE
TX
Enumeration date
02/23/2006
Last updated
08/20/2025
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