Provider Demographics
NPI:1932165347
Name:WEATHERHEAD, WILLIAM F (DO)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:F
Last Name:WEATHERHEAD
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
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Mailing Address - Street 1:721 N SHIAWASSEE ST
Mailing Address - Street 2:STE 202
Mailing Address - City:OWOSSO
Mailing Address - State:MI
Mailing Address - Zip Code:48867-1632
Mailing Address - Country:US
Mailing Address - Phone:517-332-1200
Mailing Address - Fax:517-351-7122
Practice Address - Street 1:721 N SHIAWASSEE ST
Practice Address - Street 2:STE 202
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-1632
Practice Address - Country:US
Practice Address - Phone:517-332-1200
Practice Address - Fax:517-351-7122
Is Sole Proprietor?:No
Enumeration Date:2006-04-25
Last Update Date:2016-03-09
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI5101008153207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MIE26917Medicare UPIN
MI0M59920008Medicare ID - Type Unspecified