Provider Demographics
NPI:1730109778
Name:WILLIAMS, ROBERT A (DO)
Entity Type:Individual
Prefix:DR
First Name:ROBERT
Middle Name:A
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:BOX 42
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-373-1592
Mailing Address - Fax:269-373-6270
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:STE 100
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-373-1592
Practice Address - Fax:269-373-6270
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI5101012289207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1730109778Medicaid
MI0C97618OtherBLUE CROSS BLUE SHIELD
MI1417961137OtherBCBSM - BRONSON
MI0M99460Medicare ID - Type Unspecified
MIC97618177 - BRONSONMedicare PIN
MIC97618177Medicare PIN
MI0C97618OtherBLUE CROSS BLUE SHIELD