Healthcare Provider Details

I. General information

NPI: 1750544011
Provider Name (Legal Business Name): MICHAEL STEPHEN WILLIAMS JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2008
Last Update Date: 03/22/2021
Certification Date: 03/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 S GRAND BLVD DEPT OF
SAINT LOUIS MO
63104-1016
US

IV. Provider business mailing address

1008 S SPRING AVE
SAINT LOUIS MO
63110-2520
US

V. Phone/Fax

Practice location:
  • Phone: 314-977-4730
  • Fax: 314-977-1642
Mailing address:
  • Phone: 314-977-4730
  • Fax: 314-977-1642

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number2008016771
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: