Healthcare Provider Details

I. General information

NPI: 1457387359
Provider Name (Legal Business Name): DR. MICHAEL NEAL WILLIAMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4902 E 21ST ST N
WICHITA KS
67208-1601
US

IV. Provider business mailing address

4902 E 21ST ST N
WICHITA KS
67208-1601
US

V. Phone/Fax

Practice location:
  • Phone: 316-684-1470
  • Fax:
Mailing address:
  • Phone: 316-684-1470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223D0001X
TaxonomyPublic Health Dentistry
License Number480920066
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: