Provider Demographics
NPI:1336234400
Name:WILLIAMS, MICHAEL DWAYNE (PA)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DWAYNE
Last Name:WILLIAMS
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Gender:M
Credentials:PA
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Mailing Address - Street 1:1481 W 10TH ST
Mailing Address - Street 2:RLR VAMC
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46202-2803
Mailing Address - Country:US
Mailing Address - Phone:317-554-0000
Mailing Address - Fax:317-998-2422
Practice Address - Street 1:1481 W 10TH ST
Practice Address - Street 2:RLR VAMC
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-2803
Practice Address - Country:US
Practice Address - Phone:317-554-0000
Practice Address - Fax:317-998-2422
Is Sole Proprietor?:No
Enumeration Date:2006-10-04
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN0363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical