Provider Demographics
NPI:1700877115
Name:STEELY, WILLIAM MELVIN (DPM)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:MELVIN
Last Name:STEELY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:575 MALL BLVD
Mailing Address - Street 2:SUITE L2
Mailing Address - City:DYERSBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38024-1661
Mailing Address - Country:US
Mailing Address - Phone:731-285-3338
Mailing Address - Fax:731-286-6331
Practice Address - Street 1:575 MALL BLVD
Practice Address - Street 2:SUITE L2
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1661
Practice Address - Country:US
Practice Address - Phone:731-285-3338
Practice Address - Fax:731-286-6331
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2009-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNDPM0000000571213E00000X
MO2001011234213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3271527OtherUNITED HEALTHCARE
MO305389009Medicaid
TN3727102Medicaid
TN7745188OtherAETNA
TN4058957OtherBLUE CROSS BLUE SHIELD
MO000021498Medicare PIN
TN3271527OtherUNITED HEALTHCARE
MO305389009Medicaid