Provider Demographics
NPI:1912994849
Name:WILLEN, MICHAEL (MD)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WILLEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 CROSSING BLVD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CLIFTON PARK
Mailing Address - State:NY
Mailing Address - Zip Code:12065-4154
Mailing Address - Country:US
Mailing Address - Phone:518-831-4434
Mailing Address - Fax:518-831-4435
Practice Address - Street 1:3 CROSSING BLVD
Practice Address - Street 2:SUITE 1
Practice Address - City:CLIFTON PARK
Practice Address - State:NY
Practice Address - Zip Code:12065-4154
Practice Address - Country:US
Practice Address - Phone:518-831-4434
Practice Address - Fax:518-831-4435
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-05
Last Update Date:2019-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY131246207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
C60915Medicare UPIN
56918VMedicare PIN
900001752Medicare PIN