Provider Demographics
NPI:1821209495
Name:WILLIAMS, TROY ROBERT KEONI (MD)
Entity Type:Individual
Prefix:DR
First Name:TROY
Middle Name:ROBERT KEONI
Last Name:WILLIAMS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:29900 LORRAINE AVE
Mailing Address - Street 2:SUITE 400
Mailing Address - City:WARREN
Mailing Address - State:MI
Mailing Address - Zip Code:48093-5266
Mailing Address - Country:US
Mailing Address - Phone:586-582-0864
Mailing Address - Fax:586-582-0964
Practice Address - Street 1:11012 E 13 MILE RD
Practice Address - Street 2:SUITE 112
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48093-2572
Practice Address - Country:US
Practice Address - Phone:586-573-6880
Practice Address - Fax:586-573-2562
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2013-11-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MI4301086207207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0E06376OtherMEDICARE GROUP NUMBER
MI700E063760OtherBCBS OF MICHIGAN GROUP NUMBER
MI0951909OtherBCBS PIN
MI1184828451OtherFACILITY NPI
MI1821209495Medicaid
MI1821209495Medicare PIN
MI700E063760OtherBCBS OF MICHIGAN GROUP NUMBER