MEDICARE: BYRON P WILLIAMS

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1992576086
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BYRON P WILLIAMS

Provider Business Mailing Address
First Line	:	2662 GRATIOT AVE
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48207-3264
Country	:	US
Telephone Number	:	231-683-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	20145 PACKARD ST APT 2
Second Line	:
City	:	DETROIT
State	:	MI
Zip	:	48234-3168
Country	:	US
Telephone Number	:	231-683-5289
Fax Number	:

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

Provider Enumeration Date	:	01/09/2024
Last Update Date	:	01/09/2024

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Directions to “ BYRON P WILLIAMS ” Practice Location

Language	Start Address	Practice Location

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