Healthcare Provider Details

I. General information

NPI: 1578561304
Provider Name (Legal Business Name): MICHAEL GREGORY WILLIAMS MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/14/2005
Last Update Date: 08/21/2025
Certification Date: 08/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20411 W 12 MILE RD STE 102
SOUTHFIELD MI
48076-6404
US

IV. Provider business mailing address

20411 W 12 MILE RD STE 102
SOUTHFIELD MI
48076-6404
US

V. Phone/Fax

Practice location:
  • Phone: 248-905-3194
  • Fax: 248-905-3548
Mailing address:
  • Phone: 248-905-3194
  • Fax: 248-905-3548

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number4301049187
License Number StateMI
# 2
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMW049187
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: