MEDICARE: DR. WILLIAM T. CORRELL D.O.

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	207Q00000X	Family Medicine Physician	5101014163	MI
2	207Q00000X	Family Medicine Physician	02007492A	IN
3	207P00000X	Emergency Medicine Physician	5101014163DO	MI

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
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	1022813	OTHER	MI	MHP HAN INDIVIDUAL
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	080D410020	OTHER	MI	BDBSM COM BLUE
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	1022851	OTHER	MI	MHP HAN GROUP

General Provider Information

NPI Number	:	1154371581
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM T. CORRELL D.O.

Provider Business Mailing Address
First Line	:	5215 HOLY CROSS PKWY
Second Line	:
City	:	MISHAWAKA
State	:	IN
Zip	:	46545-1469
Country	:	US
Telephone Number	:	574-335-8707
Fax Number	:	574-335-0074

Provider Business Practice Location Address
First Line	:	1919 LAKE AVE STE 106
Second Line	:
City	:	PLYMOUTH
State	:	IN
Zip	:	46563-7830
Country	:	US
Telephone Number	:	574-335-5220
Fax Number	:	574-335-0859

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

Provider Enumeration Date	:	05/10/2006
Last Update Date	:	01/13/2026

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