Healthcare Provider Details

I. General information

NPI: 1225368301
Provider Name (Legal Business Name): WILLIAM W. MARTIN, MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/12/2010
Last Update Date: 01/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5575 CONNER SUITE 208
DETROIT MI
48213
US

IV. Provider business mailing address

969 TROMBLEY RD
GROSSE POINTE PARK MI
48230-1836
US

V. Phone/Fax

Practice location:
  • Phone: 313-909-0470
  • Fax:
Mailing address:
  • Phone: 313-909-0470
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number4301052880
License Number StateMI

VIII. Authorized Official

Name: WILLIAM W MARTIN
Title or Position: DIRECTOR
Credential: MD
Phone: 313-909-0470