Provider Demographics
NPI:1225112915
Name:WILLIAMS, CHARLES H (DO)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:H
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1570 SUNCREST DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1154
Mailing Address - Country:US
Mailing Address - Phone:810-667-0500
Mailing Address - Fax:810-664-8728
Practice Address - Street 1:1570 SUNCREST DR
Practice Address - Street 2:
Practice Address - City:LAPEER
Practice Address - State:MI
Practice Address - Zip Code:48446-1154
Practice Address - Country:US
Practice Address - Phone:810-667-0500
Practice Address - Fax:810-664-8728
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2016-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI51010039092084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI7510711OtherHEALTH PLUS
MI1007731OtherMCLAREN HEALTH PLAN
MI750910711OtherBCBS
MI1007731OtherMCLAREN HEALTH ADVANTAGE
MI1866501 TYPE 11Medicaid
MIF33341Medicare UPIN
MI1007731OtherMCLAREN HEALTH ADVANTAGE