Provider Demographics
NPI:1396736807
Name:VASILEFF, WILLIAM JAMES (MD)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:JAMES
Last Name:VASILEFF
Suffix:
Gender:M
Credentials:MD
Other - Prefix:MR
Other - First Name:BILLY
Other - Middle Name:JAMES
Other - Last Name:VASILEFF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:525 SOUTHFIELD RD
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:MI
Mailing Address - Zip Code:48009-1620
Mailing Address - Country:US
Mailing Address - Phone:248-644-0670
Mailing Address - Fax:248-644-2619
Practice Address - Street 1:525 SOUTHFIELD RD
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:MI
Practice Address - Zip Code:48009-1620
Practice Address - Country:US
Practice Address - Phone:248-644-0670
Practice Address - Fax:248-644-2619
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2007-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIWV044693208200000X, 2086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
No2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIB43301Medicare UPIN
MIM11530001Medicare ID - Type Unspecified