Provider Demographics
NPI:1558866079
Name:WILLIAMS, MERCEDES M (MD)
Entity Type:Individual
Prefix:
First Name:MERCEDES
Middle Name:M
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MERCEDES
Other - Middle Name:
Other - Last Name:WILLIAMS WEISENBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:3301 W FOREST HOME AVE
Mailing Address - Street 2:
Mailing Address - City:MILWAUKEE
Mailing Address - State:WI
Mailing Address - Zip Code:53215-2843
Mailing Address - Country:US
Mailing Address - Phone:414-328-8650
Mailing Address - Fax:414-328-8660
Practice Address - Street 1:8905 W LINCOLN AVE STE 515
Practice Address - Street 2:
Practice Address - City:WEST ALLIS
Practice Address - State:WI
Practice Address - Zip Code:53227-2470
Practice Address - Country:US
Practice Address - Phone:414-328-8650
Practice Address - Fax:414-328-8660
Is Sole Proprietor?:No
Enumeration Date:2018-03-27
Last Update Date:2022-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR390200000X
WI74044207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI100205972Medicaid