MEDICARE: DR. STACY J WILLIAMS D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207P00000X	Emergency Medicine Physician	0102202248	VA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0158204604	OTHER	MI	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1083693972
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. STACY J WILLIAMS D.O.

Provider Business Mailing Address
First Line	:	38935 ANN ARBOR RD
Second Line	:	CREDENTIALING/PAYER CONTRACTING
City	:	LIVONIA
State	:	MI
Zip	:	48150-3397
Country	:	US
Telephone Number	:	734-632-0175
Fax Number	:	734-632-0182

Provider Business Practice Location Address
First Line	:	1500 N 28TH ST
Second Line	:	EMERGENCY MEDICINE DEPARTMENT
City	:	RICHMOND
State	:	VA
Zip	:	23223-5332
Country	:	US
Telephone Number	:	804-225-1780
Fax Number	:	804-225-1705

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/10/2006
Last Update Date	:	03/12/2013

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