Provider Demographics
NPI:1629172069
Name:STARBIRD, WILLIAM J (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:J
Last Name:STARBIRD
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 1:4000 HURON ST
Mailing Address - Street 2:
Mailing Address - City:NORTH BRANCH
Mailing Address - State:MI
Mailing Address - Zip Code:48461-8664
Mailing Address - Country:US
Mailing Address - Phone:810-688-3048
Mailing Address - Fax:810-688-2640
Practice Address - Street 1:4000 HURON ST
Practice Address - Street 2:
Practice Address - City:NORTH BRANCH
Practice Address - State:MI
Practice Address - Zip Code:48461-8664
Practice Address - Country:US
Practice Address - Phone:810-688-3048
Practice Address - Fax:810-688-2640
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2008-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301407209207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0D410160OtherMEDICARE GROUP NUMBER
MI0N26510Medicare PIN