Provider Demographics
NPI:1699809418
Name:MOSHER, WILLIAM EDWIN III (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:EDWIN
Last Name:MOSHER
Suffix:III
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 1:14700 PARK
Mailing Address - Street 2:
Mailing Address - City:CHARLEVOIX
Mailing Address - State:MI
Mailing Address - Zip Code:49720-1930
Mailing Address - Country:US
Mailing Address - Phone:231-547-4477
Mailing Address - Fax:231-547-4753
Practice Address - Street 1:14700 PARK
Practice Address - Street 2:
Practice Address - City:CHARLEVOIX
Practice Address - State:MI
Practice Address - Zip Code:49720-1930
Practice Address - Country:US
Practice Address - Phone:231-547-4477
Practice Address - Fax:231-547-4753
Is Sole Proprietor?:No
Enumeration Date:2007-03-15
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI028729207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI135652610Medicaid
MIWM0153206OtherBC BS OF MI
MI0153206163Medicare ID - Type Unspecified
MI135652610Medicaid