Healthcare Provider Details

I. General information

NPI: 1841291325
Provider Name (Legal Business Name): MICHAEL ANDERSON WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2005
Last Update Date: 02/24/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22255 GREENFIELD RD 410
SOUTHFIELD MI
48075-3710
US

IV. Provider business mailing address

15990 W 9 MILE RD
SOUTHFIELD MI
48075-4826
US

V. Phone/Fax

Practice location:
  • Phone: 248-849-2850
  • Fax: 248-849-5751
Mailing address:
  • Phone: 248-849-4226
  • Fax: 248-849-4240

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number4301041998
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: