Provider Demographics
NPI:1962464982
Name:WILLIAMS, STEPHEN A (MD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:A
Last Name:WILLIAMS
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 1:1639 E BIG BEAVER RD STE 202
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MI
Mailing Address - Zip Code:48083-2054
Mailing Address - Country:US
Mailing Address - Phone:248-606-4190
Mailing Address - Fax:248-598-5088
Practice Address - Street 1:1639 E BIG BEAVER RD STE 202
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MI
Practice Address - Zip Code:48083-2054
Practice Address - Country:US
Practice Address - Phone:248-606-4190
Practice Address - Fax:248-598-5088
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301073784207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI418866710Medicaid
1962464982OtherRAILROAD MEDICARE
G99137Medicare UPIN
M12070004Medicare ID - Type Unspecified