MEDICARE: DONALD H WILLIAMS MD PLLC

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	103TB0200X	Cognitive & Behavioral Psychologist	DW046913	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2603320031	OTHER	MI	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1467517573
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DONALD H WILLIAMS MD PLLC

Provider Business Mailing Address
First Line	:	425 W GRAND RIVER AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4201
Country	:	US
Telephone Number	:	517-332-8900
Fax Number	:	517-351-2733

Provider Business Practice Location Address
First Line	:	425 W GRAND RIVER AVE
Second Line	:
City	:	EAST LANSING
State	:	MI
Zip	:	48823-4201
Country	:	US
Telephone Number	:	517-332-8900
Fax Number	:	517-351-2733

Authorized Official
Title or Position	:	PSYCHIATRIST
Name	:	DR. DONALD H WILLIAMS
Credential	:	M.D.
Telephone Number	:	517-332-8900

Provider Enumeration Date	:	12/27/2006
Last Update Date	:	11/23/2009

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