Provider Demographics
NPI:1629082870
Name:ANDERSON, WILLIAM G II (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:G
Last Name:ANDERSON
Suffix:II
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20216 FARMINGTON RD
Mailing Address - Street 2:
Mailing Address - City:LIVONIA
Mailing Address - State:MI
Mailing Address - Zip Code:48152-1412
Mailing Address - Country:US
Mailing Address - Phone:248-477-0055
Mailing Address - Fax:248-477-0088
Practice Address - Street 1:20216 FARMINGTON RD
Practice Address - Street 2:
Practice Address - City:LIVONIA
Practice Address - State:MI
Practice Address - Zip Code:48152-1412
Practice Address - Country:US
Practice Address - Phone:248-477-0055
Practice Address - Fax:248-477-0088
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2014-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWA007008207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE37376Medicare UPIN
MI0P08910001Medicare PIN
MI52797OtherOMNICARE
MI000000001641OtherCAPE HEALTH PLAN
MI1656314474OtherBCBS
MI114707750Medicaid
MI015744OtherMIDWEST HEALTH
MIE37376Medicare UPIN
MI0P08910001Medicare PIN