Provider Demographics
NPI:1477662690
Name:WILLIAMS, ANTONIO JUAN SR (MD)
Entity Type:Individual
Prefix:
First Name:ANTONIO
Middle Name:JUAN
Last Name:WILLIAMS
Suffix:SR
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1447 N HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48602
Mailing Address - Country:US
Mailing Address - Phone:989-583-7076
Mailing Address - Fax:989-583-7086
Practice Address - Street 1:800 COOPER ST SUITE 9
Practice Address - Street 2:
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48602
Practice Address - Country:US
Practice Address - Phone:989-583-7076
Practice Address - Fax:989-583-7086
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2021-03-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301091198208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1477662690Medicaid
MIAW091198OtherBCBS
MI1477662690Medicaid