Provider Demographics
NPI:1508812231
Name:WILLIAMS, MARILYN BETH (MD)
Entity Type:Individual
Prefix:
First Name:MARILYN
Middle Name:BETH
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:BETH
Other - Last Name:GERSTACKER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:12851 E GRAND RIVER AVE
Mailing Address - Street 2:BRIGHTON HOSPITAL
Mailing Address - City:BRIGHTON
Mailing Address - State:MI
Mailing Address - Zip Code:48116-9969
Mailing Address - Country:US
Mailing Address - Phone:810-225-2552
Mailing Address - Fax:810-227-2270
Practice Address - Street 1:12851 E GRAND RIVER AVE
Practice Address - Street 2:BRIGHTON HOSPITAL
Practice Address - City:BRIGHTON
Practice Address - State:MI
Practice Address - Zip Code:48116-9969
Practice Address - Country:US
Practice Address - Phone:810-225-2552
Practice Address - Fax:810-227-2270
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301033262207QA0401X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI010H26253OtherBLUE CROSS
MI010H26253OtherBLUE CROSS
MI010H26253Medicare ID - Type Unspecified