MEDICARE: SHELLY L WILLIAMS, DO PLLC

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	261QP2300X	Primary Care Clinic/Center	5101009366	MI

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P01260001	OTHER		MEDICARE INDIVIDUAL NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	1205859956	OTHER		INDIVIDUAL NPI NUMBER

General Provider Information

NPI Number	:	1154577419
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SHELLY L WILLIAMS, DO PLLC

Provider Business Mailing Address
First Line	:	318 CENTER ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-3113
Country	:	US
Telephone Number	:	231-719-0798
Fax Number	:	231-744-8570

Provider Business Practice Location Address
First Line	:	318 CENTER ST
Second Line	:
City	:	MUSKEGON
State	:	MI
Zip	:	49445-3113
Country	:	US
Telephone Number	:	231-719-0798
Fax Number	:	231-744-8570

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	SHELLY L WILLIAMS
Credential	:	DO
Telephone Number	:	231-719-0798

Provider Enumeration Date	:	08/18/2008
Last Update Date	:	02/08/2011

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