Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207QA0401X | Family Doctor - Addiction Medicine | 4301033262 | MI |
NPI | 1508812231 |
---|---|
Provider Name | Marilyn Beth Williams |
First Address | Brighton, MI 48116-9969 |
Second Address | Brighton, MI 48116-9969 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
010H26253 | BLUE CROSS (01) | MI |
A73311 | (02) |