MEDICARE: DR. BASIMA 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	207Q00000X	Family Medicine Physician	2005036218	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205897055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. BASIMA WILLIAMS D.O.

Provider Business Mailing Address
First Line	:	1551 WALL ST
Second Line	:	SUITE 310
City	:	SAINT CHARLES
State	:	MO
Zip	:	63303-3539
Country	:	US
Telephone Number	:	636-669-2268
Fax Number	:	636-669-2401

Provider Business Practice Location Address
First Line	:	7421 HIGHWAY N
Second Line	:
City	:	DARDENNE PRAIRIE
State	:	MO
Zip	:	63368-7014
Country	:	US
Telephone Number	:	636-561-5699
Fax Number	:	636-669-2401

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

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	05/06/2016

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