Provider Demographics
NPI:1942338223
Name:WILLIAM L. BRISTOL, M.D.,P.C.
Entity Type:Organization
Organization Name:WILLIAM L. BRISTOL, M.D.,P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:M.D.
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:LAWRENCE
Authorized Official - Last Name:BRISTOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:586-772-6850
Mailing Address - Street 1:19611 E 8 MILE RD
Mailing Address - Street 2:
Mailing Address - City:SAINT CLAIR SHORES
Mailing Address - State:MI
Mailing Address - Zip Code:48080-1655
Mailing Address - Country:US
Mailing Address - Phone:586-772-6850
Mailing Address - Fax:586-772-3810
Practice Address - Street 1:19611 E 8 MILE RD
Practice Address - Street 2:
Practice Address - City:SAINT CLAIR SHORES
Practice Address - State:MI
Practice Address - Zip Code:48080-1655
Practice Address - Country:US
Practice Address - Phone:586-772-6850
Practice Address - Fax:586-772-3810
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2007-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301041393207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0P42980Medicare PIN
MIA76975Medicare UPIN