Provider Demographics
NPI:1205859956
Name:WILLIAMS, SHELLY L (DO)
Entity Type:Individual
Prefix:DR
First Name:SHELLY
Middle Name:L
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:318 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:NORTH MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49445-3113
Mailing Address - Country:US
Mailing Address - Phone:231-719-0798
Mailing Address - Fax:231-744-8570
Practice Address - Street 1:318 CENTER ST
Practice Address - Street 2:
Practice Address - City:NORTH MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49445-3113
Practice Address - Country:US
Practice Address - Phone:231-719-0798
Practice Address - Fax:231-744-8570
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5101009366207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI4736780Medicaid
MIE26792Medicare UPIN
MI4736780Medicaid
MIPO126001Medicare ID - Type UnspecifiedMEDICARE ID NUMBER