Provider Demographics
NPI:1336706308
Name:WILLIAMS, DEMARCO QUINDELL I (DO)
Entity Type:Individual
Prefix:DR
First Name:DEMARCO
Middle Name:QUINDELL
Last Name:WILLIAMS
Suffix:I
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:DEMARCO
Other - Middle Name:QUINDELL
Other - Last Name:WILLIAMS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CERTIFIED BUSINESS
Mailing Address - Street 1:500 N EDWARDS ST
Mailing Address - Street 2:
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-3600
Mailing Address - Country:US
Mailing Address - Phone:269-343-6073
Mailing Address - Fax:
Practice Address - Street 1:1822 E MAIN ST
Practice Address - Street 2:
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49048-1920
Practice Address - Country:US
Practice Address - Phone:269-544-9877
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-24
Last Update Date:2019-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZB0301XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherBiomedical EngineeringGroup - Multi-Specialty