Healthcare Provider Details

I. General information

NPI: 1255313268
Provider Name (Legal Business Name): BRIAN D WILLIAMSON MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 10/20/2020
Certification Date: 10/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 INVESTMENT DR SUITE 200
TROY MI
48098-6365
US

IV. Provider business mailing address

4600 INVESTMENT DR SUITE 200
TROY MI
48098-6365
US

V. Phone/Fax

Practice location:
  • Phone: 248-267-5050
  • Fax: 248-267-5051
Mailing address:
  • Phone: 248-267-5050
  • Fax: 248-267-5051

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RC0001X
TaxonomyClinical Cardiac Electrophysiology Physician
License Number4301407031
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: