Provider Demographics
NPI:1821191180
Name:WILLIAMS, PAMELA BERRY (MD)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:BERRY
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LOUISE
Other - Last Name:BERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:5555 CONNER ST STE 2691
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48213-3812
Mailing Address - Country:US
Mailing Address - Phone:313-692-8400
Mailing Address - Fax:313-692-8431
Practice Address - Street 1:5555 CONNER ST
Practice Address - Street 2:SUITE 2691
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48213-3448
Practice Address - Country:US
Practice Address - Phone:313-579-4000
Practice Address - Fax:313-579-4063
Is Sole Proprietor?:No
Enumeration Date:2006-09-05
Last Update Date:2021-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2018-02994207Q00000X
NY297055207Q00000X
ARE-11911207Q00000X
IN01081567A207Q00000X
TXS0407207Q00000X
MI4301065900207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIG85646Medicare UPIN