Provider Demographics
NPI:1952303760
Name:FACEY, WILLIAM (MD)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:FACEY
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3740 W SYLVANIA AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4461
Mailing Address - Country:US
Mailing Address - Phone:419-473-6601
Mailing Address - Fax:419-479-6966
Practice Address - Street 1:3740 W SYLVANIA AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4461
Practice Address - Country:US
Practice Address - Phone:419-473-6601
Practice Address - Fax:419-479-6966
Is Sole Proprietor?:No
Enumeration Date:2005-08-11
Last Update Date:2012-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040722207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH00247OtherPARAMOUNT
OH080130444OtherRRMC
OH000000141193OtherANTHEM
OH01-03280OtherUHC
OH0633930OtherAETNA
OH0686100Medicaid
OH00247OtherPARAMOUNT
OH0633930OtherAETNA