Healthcare Provider Details

I. General information

NPI: 1366581209
Provider Name (Legal Business Name): MICHAEL J WILLIAMSON D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2007
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1100 REID PKWY REID HOSPITAL & HEALTH CARE SERVICES
RICHMOND IN
47374-1157
US

IV. Provider business mailing address

1100 REID PKWY REID HOSPITAL & HEALTH CARE SERVICES
RICHMOND IN
47374-1157
US

V. Phone/Fax

Practice location:
  • Phone: 765-935-8773
  • Fax: 765-935-8774
Mailing address:
  • Phone: 765-935-8773
  • Fax: 765-935-8774

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number02002568A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number02002568A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: