Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | 4301407031 | MI |
NPI | 1255313268 |
---|---|
Provider Name | Brian D Williamson |
First Address | Troy, MI 48098-6365 |
Second Address | Troy, MI 48098-6365 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 16/11/2005 |
Last Update Date | 20/10/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
060069744 | MEDICARE RAILROAD (01) | MI |
0606344581 | BLUE CROSS BLUE SHIELD OF MI (01) | MI |
4445236 | (05) | MI |
F55464 | (02) | MI |