Healthcare Provider Details

I. General information

NPI: 1508809252
Provider Name (Legal Business Name): DANIEL E WILLIAMS M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 IDAHO ST
LEWISTON ID
83501-1965
US

IV. Provider business mailing address

1540 LAKE LANSING RD STE 103
LANSING MI
48912-3756
US

V. Phone/Fax

Practice location:
  • Phone: 208-743-7427
  • Fax:
Mailing address:
  • Phone: 517-913-3890
  • Fax: 517-913-3891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number4301030881
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberMC-0528
License Number StateID
# 3
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number01090600A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: