Healthcare Provider Details

I. General information

NPI: 1750446217
Provider Name (Legal Business Name): MALCOLM EDWARD WILLIAMSON DO
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 12/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8432 THORNTREE DRIVE
GROSSE ILE MI
48138
US

IV. Provider business mailing address

8432 THORNTREE DRIVE
GROSSE ILE MI
48138
US

V. Phone/Fax

Practice location:
  • Phone: 734-675-3319
  • Fax: 734-692-5061
Mailing address:
  • Phone: 734-675-3319
  • Fax: 734-692-5061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License Number5101005793
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code207U00000X
TaxonomyNuclear Medicine Physician
License Number5101005793
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: