Healthcare Provider Details

I. General information

NPI: 1891505780
Provider Name (Legal Business Name): MELANIE WILLIAMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/13/2025
Last Update Date: 05/05/2026
Certification Date: 05/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

730 N MACOMB ST STE 429
MONROE MI
48162-2904
US

IV. Provider business mailing address

2940 N MCCORD RD
TOLEDO OH
43615-1753
US

V. Phone/Fax

Practice location:
  • Phone: 734-457-5580
  • Fax: 734-244-7368
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number50.010246RX
License Number StateOH
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number5601013817
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: