Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207Q00000X | Family Doctor | 49092 | WI |
NPI | 1003850967 |
---|---|
Provider Name | Michael D Williams |
First Address | Appleton, WI 54912-8003 |
Second Address | Shawano, WI 54166-7072 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/06/2006 |
Last Update Date | 22/03/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I20508 | (02) | UT |