Provider Demographics
NPI:1831131853
Name:CORSINI, WILLIAM
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:CORSINI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1060 S VAN DYKE RD
Mailing Address - Street 2:
Mailing Address - City:BAD AXE
Mailing Address - State:MI
Mailing Address - Zip Code:48413-9631
Mailing Address - Country:US
Mailing Address - Phone:989-269-8701
Mailing Address - Fax:989-269-7226
Practice Address - Street 1:1060 S VAN DYKE RD
Practice Address - Street 2:
Practice Address - City:BAD AXE
Practice Address - State:MI
Practice Address - Zip Code:48413-9631
Practice Address - Country:US
Practice Address - Phone:989-269-8701
Practice Address - Fax:989-269-7226
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI39677208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1543289Medicaid
MIB44111Medicare UPIN
MI0320016Medicare ID - Type Unspecified