Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RE0101X | Endocrinologist (Diabetes Doctor) | 5101005793 | MI |
N | 207U00000X | Nuclear Medicine Specialist | 5101005793 | MI |
NPI | 1750446217 |
---|---|
Provider Name | Dr. Malcolm Edward Williamson |
First Address | Grosse Ile, MI 48138 |
Second Address | Grosse Ile, MI 48138 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/12/2006 |
Last Update Date | 31/12/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1296713 | (05) | MI |
5823063 | BCBS (01) | MI |
E31658 | (02) |