Willis, Kenneth Dean
Willis, Kenneth Dean is an sole proprietor health care provider with primary practice located at 3007 Memorial Pkwy Sw , Huntsville AL 35801-5393. He recently has only one registered license in Allopathic & Osteopathic Physicians / Pain Medicine, which is considered as his primary health care specialty. Willis, Kenneth Dean can be contacted via phone (256) 882-2003.Contact Information
Primary practice address
3007 Memorial Pkwy Sw
Huntsville AL 35801-5393
Phone: (256) 882-2003
Fax: (256) 705-4630
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Pain Medicine | 207LP2900X | 12320 | Alabama |
Profile Details
| NPI number | 1053486704 |
|---|---|
| LBN Legal business name | Willis, Kenneth Dean |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Nov 21st, 2006 |
| Last updated | Jan 6th, 2017 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1053486704 | NPPES |
| Alabama | MEDICAID | 529908240 |
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