Healthcare Provider Details

I. General information

NPI: 1508812231
Provider Name (Legal Business Name): MARILYN BETH WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

Provider Other Name: MARILYN BETH GERSTACKER

II. Dates (important events)

Enumeration Date: 05/25/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12851 E GRAND RIVER AVE BRIGHTON HOSPITAL
BRIGHTON MI
48116-9969
US

IV. Provider business mailing address

12851 E GRAND RIVER AVE BRIGHTON HOSPITAL
BRIGHTON MI
48116-9969
US

V. Phone/Fax

Practice location:
  • Phone: 810-225-2552
  • Fax: 810-227-2270
Mailing address:
  • Phone: 810-225-2552
  • Fax: 810-227-2270

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207QA0401X
TaxonomyAddiction Medicine (Family Medicine) Physician
License Number4301033262
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: