Individual
MARC B WILLAGE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
213 W MAIN ST, VEVAY, IN 47043-1127
(812) 427-2911
(812) 427-9056
Mailing address
PO BOX 189, MADISON, IN 47250-0189
(812) 427-2911
(812) 427-9056
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
01037094
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000042208
ANTHEM BCBS
IN
01
—
080137279
MEDICARE RAILROAD
—
05
—
100110720A
—
IN
01
—
412890P
SIHO
IN
01
—
4386715
AETNA
—
05
—
64876097
—
KY
Enumeration date
07/05/2006
Last updated
06/25/2013
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