Provider Demographics
NPI:1811417520
Name:WILLIAMS, ELLEN B (MD)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:B
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 S CANTON CENTER RD STE 200
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:MI
Mailing Address - Zip Code:48188-6276
Mailing Address - Country:US
Mailing Address - Phone:734-398-7880
Mailing Address - Fax:
Practice Address - Street 1:1600 S CANTON CENTER RD STE 200
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:MI
Practice Address - Zip Code:48188-6276
Practice Address - Country:US
Practice Address - Phone:734-398-7880
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-06-23
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301112584390200000X
MI4301502437207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program