Healthcare Provider Details

I. General information

NPI: 1609068303
Provider Name (Legal Business Name): S WILLIAM PARIS MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2007
Last Update Date: 07/29/2022
Certification Date: 08/03/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16801 NEWBURGH RD STE 106
LIVONIA MI
48154-1606
US

IV. Provider business mailing address

16801 NEWBURGH RD STE 106
LIVONIA MI
48154-1606
US

V. Phone/Fax

Practice location:
  • Phone: 734-591-6660
  • Fax: 734-744-8514
Mailing address:
  • Phone: 734-591-6660
  • Fax: 734-744-8514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number4301028014
License Number StateMI

VIII. Authorized Official

Name: JASON CHRISTOPHER PARIS
Title or Position: OWNER/MD
Credential: MD
Phone: 734-591-6660