Provider Demographics
NPI:1730152729
Name:DENHOUTER, WILLARD B (MD)
Entity type:Individual
Prefix:DR
First Name:WILLARD
Middle Name:B
Last Name:DENHOUTER
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 1:990 W ANN ARBOR TRL STE 208
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MI
Mailing Address - Zip Code:48170-1297
Mailing Address - Country:US
Mailing Address - Phone:734-398-7800
Mailing Address - Fax:734-455-5219
Practice Address - Street 1:990 W ANN ARBOR TRL STE 208
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MI
Practice Address - Zip Code:48170-1297
Practice Address - Country:US
Practice Address - Phone:734-398-7800
Practice Address - Fax:734-455-5219
Is Sole Proprietor?:No
Enumeration Date:2006-02-09
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWD047353207R00000X
MI4301047353207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI17428727Medicaid
MIN70790025Medicare PIN
MI17428727Medicaid