MEDICARE: DR. WILLIAM DAVIDSON 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	208800000X	Urology Physician	WD006199	MI

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P49274	OTHER	MI	BCN
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	5820202	OTHER	MI	BCBS
4	C4111	OTHER	MI	M-CARE
5	107245	OTHER	MI	CARE CHOICES
6	22616	OTHER	MI	CARE CHOICES

General Provider Information

NPI Number	:	1932143013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WILLIAM DAVIDSON D.O.

Provider Business Mailing Address
First Line	:	16665 LYONHURST CIR
Second Line	:
City	:	NORTHVILLE
State	:	MI
Zip	:	48168-4420
Country	:	US
Telephone Number	:	248-924-2081
Fax Number	:

Provider Business Practice Location Address
First Line	:	6255 INKSTER RD
Second Line	:
City	:	GARDEN CITY
State	:	MI
Zip	:	48135-2538
Country	:	US
Telephone Number	:	734-425-7230
Fax Number	:	734-425-7927

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

Provider Enumeration Date	:	06/16/2006
Last Update Date	:	03/24/2008

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