MEDICARE: ELLEN B. WILLIAMS MD

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	390200000X	Student in an Organized Health Care Education/Training Program	4301112584	MI
2	207Q00000X	Family Medicine Physician	4301502437	MI

General Provider Information

NPI Number	:	1811417520
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN B. WILLIAMS MD

Provider Business Mailing Address
First Line	:	1600 S CANTON CENTER RD STE 200
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6276
Country	:	US
Telephone Number	:	734-398-7880
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 S CANTON CENTER RD STE 200
Second Line	:
City	:	CANTON
State	:	MI
Zip	:	48188-6276
Country	:	US
Telephone Number	:	734-398-7880
Fax Number	:

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

Provider Enumeration Date	:	06/23/2017
Last Update Date	:	07/21/2022

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