Provider Demographics
NPI:1326493867
Name:WILLIAMS, MICHAEL (REV)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:REV
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 MIDDLE ST
Mailing Address - Street 2:SUITE 204
Mailing Address - City:NEWBURYPORT
Mailing Address - State:MA
Mailing Address - Zip Code:01950-2774
Mailing Address - Country:US
Mailing Address - Phone:978-210-7997
Mailing Address - Fax:
Practice Address - Street 1:23 MIDDLE ST
Practice Address - Street 2:SUITE 204
Practice Address - City:NEWBURYPORT
Practice Address - State:MA
Practice Address - Zip Code:01950-2774
Practice Address - Country:US
Practice Address - Phone:978-210-7997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-05-03
Last Update Date:2016-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175L00000XOther Service ProvidersHomeopath