Provider Demographics
NPI:1083669246
Name:WILLIAMS, MICHAEL DAVID (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 OLYMPIC PLAZA CIR STE 910
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-1915
Mailing Address - Country:US
Mailing Address - Phone:903-705-0072
Mailing Address - Fax:903-705-0068
Practice Address - Street 1:700 OLYMPIC PLAZA CIR STE 910
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-1915
Practice Address - Country:US
Practice Address - Phone:903-705-0072
Practice Address - Fax:903-705-0068
Is Sole Proprietor?:No
Enumeration Date:2006-05-24
Last Update Date:2023-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN12232085N0700X, 2085R0202X, 2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085N0700XAllopathic & Osteopathic PhysiciansRadiologyNeuroradiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX282066401Medicaid
AR135183001Medicaid
ARG43012Medicare UPIN
G43012Medicare UPIN