Healthcare Provider Details

I. General information

NPI: 1285757021
Provider Name (Legal Business Name): CHANNA B WILLIAMS DPM
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 04/09/2024
Certification Date: 04/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12301 LAKE UNDERHILL RD STE 215
ORLANDO FL
32828-4511
US

IV. Provider business mailing address

955 MINNESOTA AVE
WINTER PARK FL
32789-4926
US

V. Phone/Fax

Practice location:
  • Phone: 321-235-0692
  • Fax: 321-235-0694
Mailing address:
  • Phone: 248-915-8986
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License Number5901002245
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License NumberPO4189
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: