Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 208000000X | Pediatrician | 4301092581 | MI |
Y | 2084N0402X | Child Neurologist | 4301092581 | MI |
NPI | 1194979567 |
---|---|
Provider Name | Dr. Mitchel Todd Williams |
First Address | Detroit, MI 48201-2119 |
Second Address | Detroit, MI 48201-2119 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/11/2008 |
Last Update Date | 07/08/2013 |