Provider Demographics
NPI:1457421885
Name:WILLIAMS, PRESTON P (MD)
Entity Type:Individual
Prefix:
First Name:PRESTON
Middle Name:P
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 1:420 DELAWARE ST SE, MMC 395
Mailing Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55455
Mailing Address - Country:US
Mailing Address - Phone:612-884-0672
Mailing Address - Fax:
Practice Address - Street 1:420 DELAWARE ST SE, MMC 395
Practice Address - Street 2:UNIVERSITY OF MINNESOTA PHYSICIANS
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55455
Practice Address - Country:US
Practice Address - Phone:612-884-0672
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2012-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN19358207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
1000097OtherPREFERED ONE
0770233OtherMEDICA PRIMARY
MN100832OtherUCARE
MN127075300Medicaid
MN160028116OtherRR MEDICARE
HP22018OtherHEALTHPARTNERS
MN768412OtherARAZ-PPO
07-03456OtherMEDICA CHOICE
MN2W441W1OtherBCBS
MN768412OtherARAZ-PPO