Healthcare Provider Details

I. General information

NPI: 1275454738
Provider Name (Legal Business Name): ALISA SIMONE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/22/2026
Last Update Date: 07/22/2026
Certification Date: 07/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

560 ALTER RD
DETROIT MI
48215-2901
US

IV. Provider business mailing address

560 ALTER RD
DETROIT MI
48215-2901
US

V. Phone/Fax

Practice location:
  • Phone: 734-363-5323
  • Fax: 732-363-5323
Mailing address:
  • Phone: 734-363-5323
  • Fax: 732-363-5323

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156F00000X
TaxonomyTechnician/Technologist
License NumberW900000208653
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: