Provider Demographics
NPI:1891819421
Name:MCWILLIAMS, KENNETH MICHAEL (NMD)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:MICHAEL
Last Name:MCWILLIAMS
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4917 S ALMA SCHOOL RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85248-5632
Mailing Address - Country:US
Mailing Address - Phone:480-802-6617
Mailing Address - Fax:480-802-5711
Practice Address - Street 1:4917 S ALMA SCHOOL RD
Practice Address - Street 2:SUITE 1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85248
Practice Address - Country:US
Practice Address - Phone:480-802-6617
Practice Address - Fax:480-802-5711
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2018-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ06-934175F00000X, 175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ381701Medicaid
AZ381701Medicaid