Provider Demographics
NPI:1245246354
Name:WILLIAMS, ANTHONY DWAYNE (MD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:DWAYNE
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:23077 GREENFIELD RD
Mailing Address - Street 2:STE 231
Mailing Address - City:SOUTHFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48075-3709
Mailing Address - Country:US
Mailing Address - Phone:248-569-2160
Mailing Address - Fax:248-569-4875
Practice Address - Street 1:23077 GREENFIELD RD
Practice Address - Street 2:STE 231
Practice Address - City:SOUTHFIELD
Practice Address - State:MI
Practice Address - Zip Code:48075-3709
Practice Address - Country:US
Practice Address - Phone:248-569-2160
Practice Address - Fax:248-569-5756
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301062274207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0N16240OtherMEDICARE PTAN
MI4221369Medicaid
MI4221369Medicaid