MEDICARE: DR. GRISEL MAC WILLIAMS MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	174400000X	Specialist	ME0045706	FL
2	207R00000X	Internal Medicine Physician	ME0045706	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1053396549
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. GRISEL MAC WILLIAMS MD

Provider Business Mailing Address
First Line	:	810 E 39 PL.
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013
Country	:	US
Telephone Number	:	305-691-7018
Fax Number	:	305-691-5814

Provider Business Practice Location Address
First Line	:	810 E 39TH PL
Second Line	:
City	:	HIALEAH
State	:	FL
Zip	:	33013-2863
Country	:	US
Telephone Number	:	305-691-7018
Fax Number	:	305-691-5814

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/07/2005
Last Update Date	:	01/08/2021

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