Individual
ANDREA WILLIAMS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
22837 AVALON ST, SAINT CLAIR SHORES, MI 48080-2468
(586) 899-1950
Mailing address
26185 GREENFIELD RD, SOUTHFIELD, MI 48076-4709
(586) 899-1950
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
5601007402
MI
363A00000X
Physician Assistant
PA9105695
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
002913600
—
FL
01
—
DZ831Z
MEDICARE
FL
01
—
P00878021
RR MEDICARE
—
Enumeration date
11/08/2010
Last updated
09/20/2019
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