Provider Demographics
NPI:1578561304
Name:WILLIAMS, MICHAEL GREGORY (MD)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:GREGORY
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14650 W WARREN AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:DEARBORN
Mailing Address - State:MI
Mailing Address - Zip Code:48126-1782
Mailing Address - Country:US
Mailing Address - Phone:313-551-3941
Mailing Address - Fax:313-633-9616
Practice Address - Street 1:14650 W WARREN AVE STE 300
Practice Address - Street 2:
Practice Address - City:DEARBORN
Practice Address - State:MI
Practice Address - Zip Code:48126-1782
Practice Address - Country:US
Practice Address - Phone:313-551-3941
Practice Address - Fax:313-633-9616
Is Sole Proprietor?:No
Enumeration Date:2005-07-14
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIMW049187207P00000X
MI4301049187208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1578561304Medicaid
MIP00943709OtherRAILROAD MEDICARE IND PIN
MI0108118302OtherBCBS IND
MIMI3292001Medicare PIN
MIP00943709OtherRAILROAD MEDICARE IND PIN
MIE64886Medicare UPIN