Provider Demographics
NPI:1932143013
Name:DAVIDSON, WILLIAM (DO)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:
Last Name:DAVIDSON
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16665 LYONHURST CIR
Mailing Address - Street 2:
Mailing Address - City:NORTHVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48168-4420
Mailing Address - Country:US
Mailing Address - Phone:248-924-2081
Mailing Address - Fax:
Practice Address - Street 1:6255 INKSTER RD
Practice Address - Street 2:
Practice Address - City:GARDEN CITY
Practice Address - State:MI
Practice Address - Zip Code:48135-2538
Practice Address - Country:US
Practice Address - Phone:734-425-7230
Practice Address - Fax:734-425-7927
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWD006199208800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208800000XAllopathic & Osteopathic PhysiciansUrology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIP49274OtherBCN
MI1886021-11Medicaid
MI5820202OtherBCBS
MIC4111OtherM-CARE
MI107245OtherCARE CHOICES
MI22616OtherCARE CHOICES
MIC4111OtherM-CARE
MI5820202OtherBCBS