Healthcare Provider Details

I. General information

NPI: 1053059782
Provider Name (Legal Business Name): IMANI MICHAELA WILLIAMS MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

840 WALNUT ST STE 920
PHILADELPHIA PA
19107-5180
US

IV. Provider business mailing address

840 WALNUT ST STE 920
PHILADELPHIA PA
19107-5180
US

V. Phone/Fax

Practice location:
  • Phone: 215-928-3000
  • Fax:
Mailing address:
  • Phone: 215-928-3180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207WX0120X
TaxonomyCornea and External Diseases Specialist Physician
License NumberMD494910
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD494910
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: