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Individual

DR. THOMAS RICE WILLETT

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
D.O.

Contact information

Practice address
N6205 BUSSE RD, GREEN LAKE, WI 54941-8500
(920) 294-3444
(920) 294-6660
Mailing address
PO BOX 429, N6250 BUSSE DRIVE, GREEN LAKE, WI 54941-0429
(920) 294-3444
(920) 294-6660

Taxonomy

Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
17659
WI

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
30020000
WI
01
391253020
TAX IDENTIFICATION NUMBER
WI
01
391253020013
BLUE CROSS/BLUE SHIELD
WI
Enumeration date
07/28/2005
Last updated
12/31/2009
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