Provider Demographics
NPI:1568433191
Name:ATHENS, WILLIAM A JR (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:A
Last Name:ATHENS
Suffix:JR
Gender:M
Credentials:DO
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Mailing Address - Street 1:25755 TELEGRAPH RD
Mailing Address - Street 2:
Mailing Address - City:BROWNSTOWN
Mailing Address - State:MI
Mailing Address - Zip Code:48134-1013
Mailing Address - Country:US
Mailing Address - Phone:734-782-7003
Mailing Address - Fax:734-782-7005
Practice Address - Street 1:25755 TELEGRAPH RD
Practice Address - Street 2:
Practice Address - City:BROWNSTOWN
Practice Address - State:MI
Practice Address - Zip Code:48134-1013
Practice Address - Country:US
Practice Address - Phone:734-782-7003
Practice Address - Fax:734-782-7005
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-31
Last Update Date:2009-12-18
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Provider Licenses
StateLicense IDTaxonomies
MIWA011454207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1568433191OtherIND NPI
MI1538198700OtherGROUP NPI
MI2058214234OtherBCBS
MI200H234470OtherBCBS GROUP PIN
MI4891150Medicaid
MI1538198700OtherGROUP NPI
MI4891150Medicaid