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Individual
WILLIAM PAUL PENN
Active
Individual
WILLIAM PAUL PENN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.O.
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
00594
MI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
081045005
RAILROAD MEDICARE
—
01
—
108151
MERCY CARE CHOICES
MI
01
—
25872
OMNI CARE
MI
05
—
2791058
—
MI
01
—
5822444
BLUE PREF. PLUS PPO
MI
Enumeration date
07/05/2005
Last updated
11/19/2009
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