Provider Demographics
NPI:1649584012
Name:COTTRELL, WILLIAM JOHN III (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:JOHN
Last Name:COTTRELL
Suffix:III
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33 WHITE TAIL CREEK RD
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SAGINAW
Mailing Address - State:MI
Mailing Address - Zip Code:48638-5895
Mailing Address - Country:US
Mailing Address - Phone:989-752-8189
Mailing Address - Fax:
Practice Address - Street 1:33 WHITE TAIL CREEK RD
Practice Address - Street 2:SUITE 4
Practice Address - City:SAGINAW
Practice Address - State:MI
Practice Address - Zip Code:48638-5895
Practice Address - Country:US
Practice Address - Phone:989-752-8189
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-28
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIL2458549213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP34620019OtherMEDICARE PTAN